Provider Demographics
NPI:1407052020
Name:HOGUE, CARROLL BELINDA (CRNP)
Entity Type:Individual
Prefix:MS
First Name:CARROLL
Middle Name:BELINDA
Last Name:HOGUE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 WILSON AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:EUTAW
Mailing Address - State:AL
Mailing Address - Zip Code:35462-1136
Mailing Address - Country:US
Mailing Address - Phone:205-372-1260
Mailing Address - Fax:205-372-1228
Practice Address - Street 1:607 WILSON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:EUTAW
Practice Address - State:AL
Practice Address - Zip Code:35462-1136
Practice Address - Country:US
Practice Address - Phone:205-372-1260
Practice Address - Fax:205-372-1228
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1042894363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51546456OtherBLUE CROSS BLUE SHIELD
AL510I500081Medicare PIN