Individual
DR. KRISTI AMANDA BOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
501 6TH AVE S, ST PETERSBURG, FL 33701-4634
(727) 767-4243
Mailing address
1100 SOUTH BLVD, APT 322, CHARLOTTE, NC 28203-7001
(469) 617-1106
Taxonomy
Speciality
Code
Description
License number
State
2085P0229X
Pediatric Radiology Physician
TP107
KY
2085R0202X
Diagnostic Radiology Physician
Primary
ME141682
FL
2085R0204X
Vascular & Interventional Radiology Physician
TP107
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TP107
KENTUCKY MEDICAL LICENSE
KY
Enumeration date
05/12/2010
Last updated
10/11/2022
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