Provider Demographics
NPI:1639135486
Name:BOGART, ANGELA M (APRN-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:BOGART
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S SANTA FE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-4189
Mailing Address - Country:US
Mailing Address - Phone:785-452-7269
Mailing Address - Fax:785-452-6008
Practice Address - Street 1:501 S SANTA FE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-4189
Practice Address - Country:US
Practice Address - Phone:785-452-7562
Practice Address - Fax:785-452-7105
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2015-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-45729363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200333450CMedicaid
KS200333450CMedicaid
KSQ50545Medicare UPIN
KS161544Medicare ID - Type Unspecified