Healthcare Provider Details

I. General information

NPI: 1245301480
Provider Name (Legal Business Name): KATHRYN A. HOOPER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 05/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 MAIN ST
BINGHAMTON NY
13905-2524
US

IV. Provider business mailing address

303 MAIN ST
BINGHAMTON NY
13905-2524
US

V. Phone/Fax

Practice location:
  • Phone: 607-584-4465
  • Fax: 607-584-4480
Mailing address:
  • Phone: 607-584-4465
  • Fax: 607-584-4480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF330763
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF400884
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: