Healthcare Provider Details

I. General information

NPI: 1962347518
Provider Name (Legal Business Name): JENNA HOGAN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 TRENT RD
NEW BERN NC
28562-2224
US

IV. Provider business mailing address

4224 DUNHAGAN RD
GREENVILLE NC
27858-0689
US

V. Phone/Fax

Practice location:
  • Phone: 252-367-8084
  • Fax:
Mailing address:
  • Phone: 252-367-8084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6916
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: