Provider Demographics
NPI:1215999578
Name:HOGAN, KATHLEEN (FNP)
Entity type:Individual
Prefix:MISS
First Name:KATHLEEN
Middle Name:
Last Name:HOGAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3195 SOUTH MAIN STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-3749
Mailing Address - Country:US
Mailing Address - Phone:801-468-0354
Mailing Address - Fax:801-468-0353
Practice Address - Street 1:3195 SOUTH MAIN STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-3749
Practice Address - Country:US
Practice Address - Phone:801-468-0354
Practice Address - Fax:801-468-0353
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1940794405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD4243Medicaid
UT005531403Medicare PIN
UTD4243Medicaid