Healthcare Provider Details

I. General information

NPI: 1770447385
Provider Name (Legal Business Name): CHRISTINA L HOPKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 E JACKSON ST
BOLIVAR MO
65613-2026
US

IV. Provider business mailing address

PO BOX 143
BOLIVAR MO
65613-0143
US

V. Phone/Fax

Practice location:
  • Phone: 417-307-9999
  • Fax:
Mailing address:
  • Phone: 417-307-9999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2022031385
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: