Individual
MALLORY ELIZABETH BOGGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
A-GNP-C
Contact information
Practice address
159 FOUNTAINS BLVD STE B, MADISON, MS 39110-6344
(601) 859-8200
Mailing address
115 BLACKSTONE CIR, BRANDON, MS 39047-8808
(601) 720-9845
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
903821
MS
Other
Enumeration date
03/19/2020
Last updated
03/19/2020
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