GARY BRONSON BUBBA BOGGS (NPI# 1194219584) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194219584 |
| Entity Type | Individual |
| Full Name | GARY BRONSON BUBBA BOGGS |
| Credential | AGACNP |
| Practice Address |
971 Lakeland Dr Ste 1052 Jackson MS 39216-4609 |
| Practice Telephone | 6019819503 |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2018-06-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LA2100X |
Nurse Practitioner Specialization: Acute Care |
890001 | MS | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
971 LAKELAND DR STE 1052 |
| City | JACKSON |
| State | MS |
| Zip Code | 39216-4609 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760618292 | Matthew Edward Flynn | Nurse Practitioner | 971 Lakeland Dr Ste 1052, Jackson, MS 39216-4609 | 2009-06-10 |
| 1649736919 | Lea Womack | Nurse Practitioner | 971 Lakeland Dr Ste 1052, Jackson, MS 39216-4609 | 2019-02-12 |
| 1174020770 | Brandon Phillip Chambers | Nurse Practitioner | 971 Lakeland Dr Ste 1052, Jackson, MS 39216-4609 | 2018-04-10 |
| 1225397961 | Jordan Blake Carmean | Nurse Practitioner | 971 Lakeland Dr Ste 1052, Jackson, MS 39216-4609 | 2012-05-15 |
| 1275820847 | Brandon Pierce Garriga | Internal Medicine | 971 Lakeland Dr Ste 1052, Jackson, MS 39216-4609 | 2011-07-05 |
| 1326335902 | Charles E. Evans IIi | Internal Medicine | 971 Lakeland Dr Ste 1052, Jackson, MS 39216-4609 | 2011-07-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861011553 | Ashley Melancon Prewitt | Registered Nurse | St. Dominic's North Campus, Behavioral Health, Jackson, MS 39216 | 2020-04-13 |
| 1194353391 | Brianna Arrington | Student in an Organized Health Care Education/Training Program | Med/ Peds, 2500 N. State St., Jackson, MS 39216 | 2020-04-01 |
| 1720616485 | Roshina Khalid Khan | Student in an Organized Health Care Education/Training Program | Department of Anesthesiology, Ummc, 2500 N. State St., Jackson, MS 39216 | 2020-03-30 |
| 1275183550 | Amanda Lynn Morellato | Dentist | Ummc School of Dentistry, 2500 North State Street, Jackson, MS 39216 | 2019-09-18 |
| 1396305553 | Abhishek Chhabra | Student in an Organized Health Care Education/Training Program | Lakeland Family Medicine Clinic, 878 Lakeland Dr., Jackson, MS 39216 | 2019-06-19 |
| 1427615996 | Hometown Diagnostics | Clinical Medical Laboratory | Translational Research Center Tr311, 2500 North State Street, Jackson, MS 39216 | 2019-05-21 |
| 1346807773 | Shukundala C Smith | Behavior Technician | New Learning Resources 2510 Lakeland Terrace, Jackson, MS 39216 | 2019-05-21 |
| 1063901098 | G Eli Howell Md Pllc | Plastic Surgery | 971 Lakeland Dr Ste 225, Jackson, MS 39216 | 2018-05-04 |
| 1588168132 | Caleb Zumbro | Student in an Organized Health Care Education/Training Program | Ummc Med/peds, 2500 N. State St., Jackson, MS 39216 | 2018-03-20 |
| 1639677230 | Walgreen Co | Pharmacy | 971 Lakeland Dr Ste 101, Jackson, MS 39216 | 2018-01-29 |
| Find all providers in zip 39216 | ||||
| Taxonomy Code | 363LA2100X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Acute Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700240397 | Veronique Monique Lynch | Nurse Practitioner | 963 Toms River Rd, Jackson, NJ 08527-5239 | 2016-04-08 |
| 1821423484 | Katherine G Lott | Nurse Practitioner | 6295 Old Canton Rd, Apt 23b, Jackson, MS 39211-2908 | 2013-09-13 |
| 1760618292 | Matthew Edward Flynn | Nurse Practitioner | 971 Lakeland Dr Ste 1052, Jackson, MS 39216-4609 | 2009-06-10 |
| 1326649336 | Sharron Rena Brown | Nurse Practitioner | 1225 N State St, Jackson, MS 39202-2097 | 2020-11-05 |
| 1396346607 | Ashleigh Renfroe Hannah | Nurse Practitioner | 2500 N State St, Jackson, MS 39216-4500 | 2020-11-03 |
| 1770182438 | Tara P. Carter | Nurse Practitioner | 2500 N State St, Jackson, MS 39216-4500 | 2020-10-22 |
| 1437785508 | Katey Andrews | Nurse Practitioner | 2500 N State St, Jackson, MS 39216-4500 | 2020-03-20 |
| 1144854498 | Katlyn Amason | Nurse Practitioner | 501 Marshall St Ste 200, Jackson, MS 39202-1687 | 2020-02-25 |
| 1194364554 | Erica L Hawkins | Nurse Practitioner | 900 Cooper St, Jackson, MI 49202-3398 | 2020-01-03 |
| 1023664430 | Jennifer Elizabeth Overton | Nurse Practitioner | 2500 N State St, Jackson, MS 39216-4500 | 2019-08-12 |
| Find all providers in JACKSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.