Provider Demographics
NPI:1043670607
Name:HOGAN-HORTON, JENNIE ELIZABETH
Entity Type:Individual
Prefix:MRS
First Name:JENNIE
Middle Name:ELIZABETH
Last Name:HOGAN-HORTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9219 N 178TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-8000
Mailing Address - Country:US
Mailing Address - Phone:918-565-0053
Mailing Address - Fax:
Practice Address - Street 1:9219 N 178TH EAST AVE
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-8000
Practice Address - Country:US
Practice Address - Phone:918-565-0053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator