Healthcare Provider Details

I. General information

NPI: 1508568155
Provider Name (Legal Business Name): KELLY ANN HOOFMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. KELLY ANN RICHARDSON

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S GRAND BLVD
SAINT LOUIS MO
63104-1016
US

IV. Provider business mailing address

1008 S SPRING AVE
SAINT LOUIS MO
63110-2520
US

V. Phone/Fax

Practice location:
  • Phone: 314-257-8000
  • Fax: 314-977-1664
Mailing address:
  • Phone: 314-977-2605
  • Fax: 314-977-1664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2023023835
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2023023835
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: