Provider Demographics
NPI:1467115014
Name:HOGAN, CASEY WILLIAMS (APRN)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:WILLIAMS
Last Name:HOGAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 MEDICAL DR STE 325
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3389
Mailing Address - Country:US
Mailing Address - Phone:210-615-7700
Mailing Address - Fax:210-615-1782
Practice Address - Street 1:4330 MEDICAL DR STE 325
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3389
Practice Address - Country:US
Practice Address - Phone:210-615-7700
Practice Address - Fax:210-615-1782
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1057295363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care