Provider Demographics
NPI:1922762798
Name:KOGER, CARRIE JEAN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:JEAN
Last Name:KOGER
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 1:6630 COOLIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CANTRALL
Mailing Address - State:IL
Mailing Address - Zip Code:62625-8885
Mailing Address - Country:US
Mailing Address - Phone:217-971-4455
Mailing Address - Fax:
Practice Address - Street 1:319 E MADISON ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62701-1035
Practice Address - Country:US
Practice Address - Phone:217-788-3948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.024242363LF0000X
IL041.394318163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse