Active NPI
Patricia Ann Boger, PH.D.
- Clinical Psychologist
- Orange Park, FL
National Provider Identifier
1720153240
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY 3337
- Practice address
- 1732 Kingsley Ave
Suite 1
Orange Park, FL 32073-4412 - Phone
- (904) 264-0600
- Fax
- (904) 264-8972
- NPI assigned
- Nov 21, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY 3337 | FL | Primary |
Addresses
Primary practice location
1732 Kingsley Ave
Suite 1
Orange Park, FL 32073-4412
Mailing address
1732 Kingsley Ave
Suite 1
Orange Park, FL 32073-4412
Phone (904) 264-0600
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 75572 | Other | FL | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY 3337 | FL | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1720153240",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1732 KINGSLEY AVE",
"address_2": "SUITE 1",
"city": "ORANGE PARK",
"state": "FL",
"postal_code": "320734412",
"telephone_number": "904-264-0600",
"fax_number": "904-264-8972"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1732 KINGSLEY AVE",
"address_2": "SUITE 1",
"city": "ORANGE PARK",
"state": "FL",
"postal_code": "320734412",
"telephone_number": "904-264-0600",
"fax_number": "904-264-8972"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOGER",
"first_name": "PATRICIA",
"middle_name": "ANN",
"name_prefix": "Ms.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "FL",
"license": "PY 3337",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "75572",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Orange Park, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.