Healthcare Provider Details

I. General information

NPI: 1447160767
Provider Name (Legal Business Name): ELIZABETH ANN BOGGS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 SHAMROCK RD
MANCHESTER KY
40962-9201
US

IV. Provider business mailing address

330 SHAMROCK RD
MANCHESTER KY
40962-9201
US

V. Phone/Fax

Practice location:
  • Phone: 606-598-2425
  • Fax: 606-598-4448
Mailing address:
  • Phone: 606-598-2425
  • Fax: 606-598-4448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4063373
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: