Provider Demographics
NPI:1104274729
Name:HOGAN, KAITLYN MICHELLE (CNP)
Entity type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:MICHELLE
Last Name:HOGAN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3781 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-4011
Mailing Address - Country:US
Mailing Address - Phone:614-645-3163
Mailing Address - Fax:614-645-5893
Practice Address - Street 1:3781 S HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-4011
Practice Address - Country:US
Practice Address - Phone:614-645-3163
Practice Address - Fax:614-645-5893
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.19251363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily