Healthcare Provider Details

I. General information

NPI: 1447841622
Provider Name (Legal Business Name): AMANDA KRISTINE HOGG FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2021
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 E MAIN ST STE 2
GARDNER KS
66030-1314
US

IV. Provider business mailing address

314 E MAIN ST STE 2
GARDNER KS
66030-1314
US

V. Phone/Fax

Practice location:
  • Phone: 785-832-1112
  • Fax:
Mailing address:
  • Phone: 785-832-1112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-79918-051
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: