Healthcare Provider Details

I. General information

NPI: 1477939825
Provider Name (Legal Business Name): KIMBERLY N BOGAR APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2015
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 W 3RD AVE
WILLIAMSON WV
25661-3006
US

IV. Provider business mailing address

1609 W 3RD AVE
WILLIAMSON WV
25661-3006
US

V. Phone/Fax

Practice location:
  • Phone: 304-235-0026
  • Fax: 304-235-0028
Mailing address:
  • Phone: 304-235-0026
  • Fax: 304-235-0028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3009592
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: