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General NPI Number Information
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NPI Number | 1982375218
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Entity Type | Individual
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Provider Name | STEPHANIE L HOGAN PMNNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/27/2021
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Last Update Date | 08/16/2024
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Provider Practice Location Address
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Address Line | 4494 HIGHWAY 15
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City | LOUIN
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State | MS
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Zip | 39338
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Country | US
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Telephone | 404-285-6896
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Fax | 228-232-0891
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Provider Business Mailing Address
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Address Line | 4494 HIGHWAY 15
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City | LOUIN
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State | MS
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Zip | 39338
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Country | US
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Telephone | 404-285-6896
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 904568
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License Number State | MS
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