Healthcare Provider Details

I. General information

NPI: 1841451168
Provider Name (Legal Business Name): HETTY KATHLEEN BOGIE NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 10/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 BANDERA HWY SUITE 2
KERRVILLE TX
78028-9515
US

IV. Provider business mailing address

1331 BANDERA HWY SUITE 2
KERRVILLE TX
78028-9515
US

V. Phone/Fax

Practice location:
  • Phone: 830-895-7755
  • Fax: 830-895-7757
Mailing address:
  • Phone: 830-895-7755
  • Fax: 830-895-7757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number747538
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: