Healthcare Provider Details

I. General information

NPI: 1740728567
Provider Name (Legal Business Name): ABBYGAIL HOGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2017
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 NE SAINT LUKES BLVD STE 200
LEES SUMMIT MO
64086-6011
US

IV. Provider business mailing address

8600 W 131ST PL APT 514
OVERLAND PARK KS
66213-5136
US

V. Phone/Fax

Practice location:
  • Phone: 620-855-0630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number24-01322
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: