Provider Demographics
NPI:1255744744
Name:HOGGARD, TABITHA
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:HOGGARD
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 1:901 ANTELOPE RD
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:MO
Mailing Address - Zip Code:64865-8572
Mailing Address - Country:US
Mailing Address - Phone:417-775-2714
Mailing Address - Fax:417-775-2714
Practice Address - Street 1:901 ANTELOPE RD
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:MO
Practice Address - Zip Code:64865-8572
Practice Address - Country:US
Practice Address - Phone:417-775-2714
Practice Address - Fax:417-775-2714
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator