Healthcare Provider Details

I. General information

NPI: 1972258333
Provider Name (Legal Business Name): MACKENZIE LARIN HOPPER PA-C, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2022
Last Update Date: 09/11/2025
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4355 FERGUSON DR
CINCINNATI OH
45245-5136
US

IV. Provider business mailing address

1195 EMERY RIDGE DR
BATAVIA OH
45103-4047
US

V. Phone/Fax

Practice location:
  • Phone: 513-232-2663
  • Fax:
Mailing address:
  • Phone: 513-886-1249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: