Provider Demographics
NPI:1982375218
Name:HOGAN, STEPHANIE L (PMNNP-BC)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:L
Last Name:HOGAN
Suffix:
Gender:F
Credentials:PMNNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4494 HIGHWAY 15
Mailing Address - Street 2:
Mailing Address - City:LOUIN
Mailing Address - State:MS
Mailing Address - Zip Code:39338
Mailing Address - Country:US
Mailing Address - Phone:404-285-6896
Mailing Address - Fax:
Practice Address - Street 1:4494 HIGHWAY 15
Practice Address - Street 2:
Practice Address - City:LOUIN
Practice Address - State:MS
Practice Address - Zip Code:39338
Practice Address - Country:US
Practice Address - Phone:404-285-6896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904568363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health