Healthcare Provider Details

I. General information

NPI: 1336983808
Provider Name (Legal Business Name): ABBY HOGAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10407 N 143RD EAST CT
OWASSO OK
74055-5913
US

IV. Provider business mailing address

982185 NEBRASKA MEDICAL CTR
OMAHA NE
68198-2185
US

V. Phone/Fax

Practice location:
  • Phone: 918-704-6614
  • Fax:
Mailing address:
  • Phone: 402-559-5380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number10770
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: