MEDICARE: PRISCILLA HOGAN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1346870219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRISCILLA HOGAN PA-C

Provider Business Mailing Address
First Line	:	516 ELKS LAKE RD
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39401-0305
Country	:	US
Telephone Number	:	601-543-3659
Fax Number	:

Provider Business Practice Location Address
First Line	:	7127 U S HIGHWAY 98 STE 40
Second Line	:
City	:	HATTIESBURG
State	:	MS
Zip	:	39402-7034
Country	:	US
Telephone Number	:	601-467-6555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2020
Last Update Date	:	03/19/2026

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