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General NPI Number Information
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NPI Number | 1659250728
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Entity Type | Individual
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Provider Name | MADISON HOGGE KILLPACK PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/02/2025
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | WEBER STATE UNIVERSITY 3875 STADIUM WAY DEPT 3913
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City | OGDEN
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State | UT
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Zip | 84408-0001
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Country | US
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Telephone | 801-626-7210
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Fax |
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Provider Business Mailing Address
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Address Line | 2526 N 800 E
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City | NORTH OGDEN
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State | UT
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Zip | 84414-2961
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Country | US
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Telephone | 801-866-3682
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 14240615-1206
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License Number State | UT
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