Provider Demographics
NPI:1003029950
Name:HOGER, AMY L (PA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:HOGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5999
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97228-5999
Mailing Address - Country:US
Mailing Address - Phone:541-500-2500
Mailing Address - Fax:541-500-2700
Practice Address - Street 1:550 GAGE BLVD
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-9532
Practice Address - Country:US
Practice Address - Phone:509-628-1362
Practice Address - Fax:509-946-7666
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2055363A00000X
ORPA174313363A00000X
WAPA60921533363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORMDA0283Medicaid
WA2032122Medicaid