Provider Demographics
NPI:1174304042
Name:BOGAN, ABIGAIL DAVIS (PA-C)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:DAVIS
Last Name:BOGAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5341 AIRLINE DR STE 130
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-6710
Mailing Address - Country:US
Mailing Address - Phone:318-935-1820
Mailing Address - Fax:318-935-1863
Practice Address - Street 1:5341 AIRLINE DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-6710
Practice Address - Country:US
Practice Address - Phone:318-935-1820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical