Healthcare Provider Details

I. General information

NPI: 1639414725
Provider Name (Legal Business Name): KELLI K HOFFMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2012
Last Update Date: 11/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 NORTH ST
LATHROP MO
64465-9609
US

IV. Provider business mailing address

1600 E EVERGREEN ST
CAMERON MO
64429-2400
US

V. Phone/Fax

Practice location:
  • Phone: 816-740-3282
  • Fax: 816-528-3003
Mailing address:
  • Phone: 816-632-2101
  • Fax: 816-649-3383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2012039957
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: