Healthcare Provider Details

I. General information

NPI: 1619576816
Provider Name (Legal Business Name): NICHOLAS P HOFFMANN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 LEXINGTON RD
RICHMOND KY
40475-1059
US

IV. Provider business mailing address

257 SUNSET AVE APT 3
RICHMOND KY
40475-1377
US

V. Phone/Fax

Practice location:
  • Phone: 859-624-2454
  • Fax:
Mailing address:
  • Phone: 502-545-8703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: