Healthcare Provider Details

I. General information

NPI: 1033550801
Provider Name (Legal Business Name): KATHARINE J HOOPER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2013
Last Update Date: 09/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 SOUTH RD SUITE 250
FARMINGTON CT
06032-2483
US

IV. Provider business mailing address

11 SOUTH RD SUITE 250
FARMINGTON CT
06032-2483
US

V. Phone/Fax

Practice location:
  • Phone: 860-674-0578
  • Fax: 860-674-0024
Mailing address:
  • Phone: 860-674-0578
  • Fax: 860-674-0024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2269721
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number006530
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: