1447661525 NPI number — MR. CHARLES DONOVAN HOOPER CRNP

Table of content: MR. CHARLES DONOVAN HOOPER CRNP (NPI 1447661525)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447661525 NPI number — MR. CHARLES DONOVAN HOOPER CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOOPER
Provider First Name:
CHARLES
Provider Middle Name:
DONOVAN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
M

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:
1447661525
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28779 NICK DAVIS R.D.
Provider Second Line Business Mailing Address:
LIMESTONE CORRECTIONAL FACILITY
Provider Business Mailing Address City Name:
HARVEST
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35749
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-233-4600
Provider Business Mailing Address Fax Number:
256-230-9417

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28779 NICK DAVIS RD.
Provider Second Line Business Practice Location Address:
LIMESTONE CORRECTIONAL FACILITY
Provider Business Practice Location Address City Name:
HARVEST
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-233-4600
Provider Business Practice Location Address Fax Number:
256-230-9417
Provider Enumeration Date:
05/12/2014

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: 363LA2100X , with the licence number:  1-077820 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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