Healthcare Provider Details

I. General information

NPI: 1902765449
Provider Name (Legal Business Name): KATHY ANN HOOPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2026
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3704 DON JANUARY AVE
CLOVIS NM
88101-2729
US

IV. Provider business mailing address

3704 DON JANUARY AVE
CLOVIS NM
88101-2729
US

V. Phone/Fax

Practice location:
  • Phone: 575-747-3687
  • Fax:
Mailing address:
  • Phone: 575-747-3687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: