Provider Demographics
NPI:1093839821
Name:HOGUE, CAROL S (RN-FNP-C)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:S
Last Name:HOGUE
Suffix:
Gender:F
Credentials:RN-FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5505 LONG LEAF DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76310-3470
Mailing Address - Country:US
Mailing Address - Phone:940-696-6469
Mailing Address - Fax:
Practice Address - Street 1:1600 8TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-3108
Practice Address - Country:US
Practice Address - Phone:940-764-3985
Practice Address - Fax:940-764-3978
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX533592363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP48485Medicare UPIN