1154190015 NPI number — KELLY LARRICK HOCKMAN MSN-ED, RN

Table of content: KELLY LARRICK HOCKMAN MSN-ED, RN (NPI 1154190015)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154190015 NPI number — KELLY LARRICK HOCKMAN MSN-ED, RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOCKMAN
Provider First Name:
KELLY
Provider Middle Name:
LARRICK
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN-ED, RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154190015
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
209 TIMBERLAKES LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEAR BROOK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22624-1604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-323-3031
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 FOXCROFT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARTINSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25401-5341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-260-0147
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/20/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WH0200X , with the licence number:  0001253893 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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