Individual provider Active NPI

Kristy Hogan, APRN

  • Family Nurse Practitioner
  • Russellville, AR
National Provider Identifier
1073979969
Registry record updated Jan 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
A002907 Issued in AR
Practice address
402 W O St
Dean Hall, Room 126
Russellville, AR 72801-8810
Phone
(479) 368-0329
NPI assigned
Jan 7, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X A002907 AR Primary

Addresses

Primary practice location

402 W O St
Dean Hall, Room 126
Russellville, AR 72801-8810

Mailing address

402 W O St
Dean Hall, Room 126
Russellville, AR 72801-8810
Phone (479) 368-0329

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170722000288 AR Practitioner - Nurse Practitioner 4688944788 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2005
Medicare assignment
May accept Medicare assignment
Group practices
Arkansas Department of Health Payroll OfficeGroup PAC ID 5799696779, 28 clinicians

Practice addresses (Care Compare)

4815 W Markham St
Little Rock, AR 72205-3866
Phone (501) 661-2000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1452124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452124800000",
    "number": "1073979969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 W O ST",
            "address_2": "DEAN HALL, ROOM 126",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728018810",
            "telephone_number": "479-368-0329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 W O ST",
            "address_2": "DEAN HALL, ROOM 126",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728018810",
            "telephone_number": "479-368-0329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOGAN",
        "first_name": "KRISTY",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-07",
        "last_updated": "2016-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AR",
            "license": "A002907",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Russellville, AR

Sources for this page

Verify at the official NPI Registry.