Provider Demographics
NPI:1972825339
Name:HOGAN, JO W (RD, LDN, CSP)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:W
Last Name:HOGAN
Suffix:
Gender:F
Credentials:RD, LDN, CSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 802
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28802-0802
Mailing Address - Country:US
Mailing Address - Phone:828-277-1315
Mailing Address - Fax:828-277-1321
Practice Address - Street 1:11 VANDERBILT PARK DR
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1700
Practice Address - Country:US
Practice Address - Phone:828-213-1740
Practice Address - Fax:828-213-1742
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL000597133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric