Provider Demographics
NPI:1912314386
Name:BOGLE, MATTHEW M (APRN)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:M
Last Name:BOGLE
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 736
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:KS
Mailing Address - Zip Code:67357-0736
Mailing Address - Country:US
Mailing Address - Phone:620-820-5800
Mailing Address - Fax:620-820-5821
Practice Address - Street 1:2613 S SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:CHANUTE
Practice Address - State:KS
Practice Address - Zip Code:66720
Practice Address - Country:US
Practice Address - Phone:620-902-2030
Practice Address - Fax:620-902-2034
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS76370363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily