Healthcare Provider Details

I. General information

NPI: 1598355240
Provider Name (Legal Business Name): KELLY HOFFMANN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2021
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N WINSTEAD AVE
ROCKY MOUNT NC
27804-8467
US

IV. Provider business mailing address

PO BOX 7200
ROCKY MOUNT NC
27804-0200
US

V. Phone/Fax

Practice location:
  • Phone: 252-937-0235
  • Fax: 252-937-3103
Mailing address:
  • Phone: 757-416-4546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: