Provider Demographics
NPI:1740032648
Name:HOGAN, NIKKI
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:
Last Name:HOGAN
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:PO BOX 161530
Mailing Address - Street 2:
Mailing Address - City:BIG SKY
Mailing Address - State:MT
Mailing Address - Zip Code:59716-1530
Mailing Address - Country:US
Mailing Address - Phone:406-579-3757
Mailing Address - Fax:
Practice Address - Street 1:7000 BEAVER CREEK RD
Practice Address - Street 2:
Practice Address - City:GALLATIN GATEWAY
Practice Address - State:MT
Practice Address - Zip Code:59730-9681
Practice Address - Country:US
Practice Address - Phone:406-579-3757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT25326-1206171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach