Provider Demographics
NPI:1770813487
Name:HOGSTEN, PAULA JEAN (ARNP)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:JEAN
Last Name:HOGSTEN
Suffix:
Gender:F
Credentials:ARNP
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 2468
Mailing Address - Street 2:432 - 16TH STREET SUITE B
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101
Mailing Address - Country:US
Mailing Address - Phone:606-329-9335
Mailing Address - Fax:606-324-6383
Practice Address - Street 1:432 - 16TH STREET
Practice Address - Street 2:SUITE B- TRI STATE NEPHROLOGY
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101
Practice Address - Country:US
Practice Address - Phone:606-329-9335
Practice Address - Fax:606-324-6383
Is Sole Proprietor?:No
Enumeration Date:2009-12-31
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1906S364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100112090Medicaid
OH3028011Medicaid
KY1906SOtherKENTUCKY ARNP LICENSE ID NUMBER
KY7100112090Medicaid