Provider Demographics
NPI:1538301833
Name:BOGGS, CHRISTY MCCONVILLE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:MCCONVILLE
Last Name:BOGGS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:CAROL
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:119 N DAISY ST
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-4703
Mailing Address - Country:US
Mailing Address - Phone:423-839-0820
Mailing Address - Fax:423-717-6368
Practice Address - Street 1:119 N DAISY ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-4703
Practice Address - Country:US
Practice Address - Phone:423-839-0820
Practice Address - Fax:423-717-6368
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-111556363LF0000X
TN14667363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ078136Medicaid