Provider Demographics
NPI:1184208803
Name:KOGER, DEVIN REBECCA
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:REBECCA
Last Name:KOGER
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 1:934 ROSSTON RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AR
Mailing Address - Zip Code:71857-2510
Mailing Address - Country:US
Mailing Address - Phone:870-796-1181
Mailing Address - Fax:
Practice Address - Street 1:5954 HIGHWAY 29 N
Practice Address - Street 2:
Practice Address - City:BLEVINS
Practice Address - State:AR
Practice Address - Zip Code:71825-9033
Practice Address - Country:US
Practice Address - Phone:870-874-2801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-09
Last Update Date:2021-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator