Provider Demographics
NPI:1598090177
Name:HOGAN, SHANNON (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:
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 1:231 E CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1821
Mailing Address - Country:US
Mailing Address - Phone:502-629-7223
Mailing Address - Fax:502-629-8827
Practice Address - Street 1:231 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1821
Practice Address - Country:US
Practice Address - Phone:502-629-7223
Practice Address - Fax:502-629-8827
Is Sole Proprietor?:No
Enumeration Date:2009-10-15
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1101105163W00000X
KY3006225363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6225POtherARNP
KY1101105OtherRN