Healthcare Provider Details

I. General information

NPI: 1619418092
Provider Name (Legal Business Name): KATHRYN THOR BOGGS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2017
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 LEXINGTON RD
RICHMOND KY
40475-1059
US

IV. Provider business mailing address

429 S SHARON AMITY RD STE C
CHARLOTTE NC
28211-2866
US

V. Phone/Fax

Practice location:
  • Phone: 859-624-2454
  • Fax:
Mailing address:
  • Phone: 859-227-9922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number130312
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: