Healthcare Provider Details

I. General information

NPI: 1942136601
Provider Name (Legal Business Name): RYAN KEITH HOOPER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: EMMA HOOPER

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11817 SEQUANOTA HEIGHTS DR
CHARLEVOIX MI
49720-9214
US

IV. Provider business mailing address

11817 SEQUANOTA HEIGHTS DR
CHARLEVOIX MI
49720-9214
US

V. Phone/Fax

Practice location:
  • Phone: 616-340-8528
  • Fax:
Mailing address:
  • Phone: 616-340-8528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: