Provider Demographics
NPI:1912595521
Name:HOGUE, LAKEN BRYSON (FNP-C)
Entity Type:Individual
Prefix:
First Name:LAKEN
Middle Name:BRYSON
Last Name:HOGUE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 COMMONWEALTH BLVD
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-9300
Mailing Address - Country:US
Mailing Address - Phone:662-350-3106
Mailing Address - Fax:
Practice Address - Street 1:1022 COMMONWEALTH BLVD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-9300
Practice Address - Country:US
Practice Address - Phone:662-350-3106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904353363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily