Healthcare Provider Details

I. General information

NPI: 1932709961
Provider Name (Legal Business Name): TAMMY LYNN BOGGS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2020
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 W 1ST ST
MT PLEASANT TX
75455-4336
US

IV. Provider business mailing address

1715 W 5TH ST
HOPE AR
71801-8704
US

V. Phone/Fax

Practice location:
  • Phone: 903-401-8958
  • Fax:
Mailing address:
  • Phone: 319-230-9157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberP58191
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: