Provider Demographics
NPI:1144780826
Name:HOGAN, ROXIE MAE (PMHNP)
Entity Type:Individual
Prefix:
First Name:ROXIE
Middle Name:MAE
Last Name:HOGAN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20A THOMAS HOGAN RD
Mailing Address - Street 2:
Mailing Address - City:ALLIGATOR
Mailing Address - State:MS
Mailing Address - Zip Code:38720-0401
Mailing Address - Country:US
Mailing Address - Phone:662-902-1299
Mailing Address - Fax:
Practice Address - Street 1:590 HIGHWAY 6 E
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-3002
Practice Address - Country:US
Practice Address - Phone:662-563-8703
Practice Address - Fax:662-563-7736
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903125363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSHOGA-RG7658OtherPMHNP-BC