Individual
MS. TAMMY V BOGART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
235 EVERGREEN AVE, APPOMATTOX, VA 24522-4501
(434) 352-7420
Mailing address
PO BOX 8310, ROANOKE, VA 24014-0310
(540) 345-3556
(540) 342-2193
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
0024181135
VA
363L00000X
Nurse Practitioner
F302247-1
NY
363LA2200X
Adult Health Nurse Practitioner
F302247-1
NY
363LW0102X
Women's Health Nurse Practitioner
F302247-1
NY
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
F302247-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01925084
—
NY
01
—
122862CK
PREFERRED CARE PROVIDER #
NY
01
—
302247
LICENSE
NM
Enumeration date
09/25/2006
Last updated
03/02/2022
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