MEDICARE: NIKITA HOGAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246RP1900X	Phlebotomy Technician

General Provider Information

NPI Number	:	1184480477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKITA HOGAN

Provider Business Mailing Address
First Line	:	PO BOX 103
Second Line	:
City	:	TCHULA
State	:	MS
Zip	:	39169-0103
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	304 MAPLE ST
Second Line	:
City	:	TCHULA
State	:	MS
Zip	:	39169-3762
Country	:	US
Telephone Number	:	662-739-0074
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2024
Last Update Date	:	02/23/2024

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Directions to “ NIKITA HOGAN ” Practice Location

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