Provider Demographics
NPI:1740212117
Name:HOGUE, KAREY J (CNM)
Entity Type:Individual
Prefix:MS
First Name:KAREY
Middle Name:J
Last Name:HOGUE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 LAWN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-2450
Mailing Address - Country:US
Mailing Address - Phone:574-293-2893
Mailing Address - Fax:574-293-1298
Practice Address - Street 1:1215 LAWN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-2450
Practice Address - Country:US
Practice Address - Phone:574-293-2893
Practice Address - Fax:574-293-1298
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN72000012A367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200311010AMedicaid
IN000000519825OtherANTHEM BCBS #
P21967Medicare UPIN
IN200311010AMedicaid