Healthcare Provider Details

I. General information

NPI: 1154704047
Provider Name (Legal Business Name): KELLI DAWN HOGAN MSN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELLI DAWN MELDRUM APRN

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date: 11/20/2020
Reactivation Date: 03/25/2021

III. Provider practice location address

2131 S 17TH ST
WILMINGTON NC
28401-7407
US

IV. Provider business mailing address

2131 S 17TH ST
WILMINGTON NC
28401-7407
US

V. Phone/Fax

Practice location:
  • Phone: 910-667-7000
  • Fax:
Mailing address:
  • Phone: 816-701-5200
  • Fax: 910-667-7000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2020041052
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2013004374
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: