Healthcare Provider Details

I. General information

NPI: 1346061249
Provider Name (Legal Business Name): KELLY HOPKINS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2024
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 ARK RD STE 206
MOUNT LAUREL NJ
08054-3100
US

IV. Provider business mailing address

20 LONGHURST RD
MARLTON NJ
08053-1934
US

V. Phone/Fax

Practice location:
  • Phone: 856-778-4640
  • Fax:
Mailing address:
  • Phone: 609-694-4518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ15055200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: