Healthcare Provider Details

I. General information

NPI: 1316419252
Provider Name (Legal Business Name): ASHLEY C HOFER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 CROSSROADS PL STE 120
MOUNT VERNON IL
62864-6545
US

IV. Provider business mailing address

209 CROSSROADS PL STE 120
MOUNT VERNON IL
62864-6545
US

V. Phone/Fax

Practice location:
  • Phone: 618-244-6222
  • Fax:
Mailing address:
  • Phone: 618-244-6222
  • Fax: 618-244-1810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209018540
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: