Provider Demographics
NPI:1063723450
Name:BOGGS, ELIZABETH LEE (A R N P)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:LEE
Last Name:BOGGS
Suffix:
Gender:F
Credentials:A R N P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 495
Mailing Address - Street 2:2659 NORTH LAUREL ROAD
Mailing Address - City:EAST BERNSTADT
Mailing Address - State:KY
Mailing Address - Zip Code:40729-0495
Mailing Address - Country:US
Mailing Address - Phone:606-843-6195
Mailing Address - Fax:606-843-6222
Practice Address - Street 1:2659 NORTH LAUREL ROAD
Practice Address - Street 2:
Practice Address - City:EAST BERNSTADT
Practice Address - State:KY
Practice Address - Zip Code:40729-0495
Practice Address - Country:US
Practice Address - Phone:606-843-6195
Practice Address - Fax:606-843-6222
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6488P363L00000X
KY3006488363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100124680Medicaid
KYMB2553825OtherDEA
KYMB2553825OtherDEA