Provider Demographics
NPI:1124031836
Name:HOGAN, KATHLEEN WEATHERFORD (APRN GPN)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:WEATHERFORD
Last Name:HOGAN
Suffix:
Gender:F
Credentials:APRN GPN
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:BELINDA
Other - Last Name:WEATHERFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:803-296-7320
Mailing Address - Fax:
Practice Address - Street 1:14 RICHLAND MEDICAL PARK DR STE 320
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6896
Practice Address - Country:US
Practice Address - Phone:803-434-6771
Practice Address - Fax:803-434-3855
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27551363LG0600X
SC685363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0894Medicaid