Provider Demographics
NPI:1740756071
Name:HOGG, MAHKESHA CHERISH
Entity Type:Individual
Prefix:
First Name:MAHKESHA
Middle Name:CHERISH
Last Name:HOGG
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 1:5302 WILLOW CLIFF RD APT 151
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73122-6302
Mailing Address - Country:US
Mailing Address - Phone:405-501-8656
Mailing Address - Fax:
Practice Address - Street 1:5302 WILLOW CLIFF RD APT 151
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73122-6302
Practice Address - Country:US
Practice Address - Phone:405-501-8656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-13
Last Update Date:2018-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator