Provider Demographics
NPI:1821566316
Name:HOGG, KIERSTEN HACKLEY (DNP, FNP)
Entity Type:Individual
Prefix:
First Name:KIERSTEN
Middle Name:HACKLEY
Last Name:HOGG
Suffix:
Gender:F
Credentials:DNP, FNP
Other - Prefix:
Other - First Name:KIERSTEN
Other - Middle Name:
Other - Last Name:HACKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:533 NW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-1707
Mailing Address - Country:US
Mailing Address - Phone:208-779-1481
Mailing Address - Fax:
Practice Address - Street 1:533 NW 2ND ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-1707
Practice Address - Country:US
Practice Address - Phone:208-779-1481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201809918NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily