Healthcare Provider Details

I. General information

NPI: 1427372531
Provider Name (Legal Business Name): KRISTI HOPPER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2010
Last Update Date: 03/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 RAILROAD STREET
KINGSTON OH
45644-0203
US

IV. Provider business mailing address

PO BOX 203
KINGSTON OH
45644-0203
US

V. Phone/Fax

Practice location:
  • Phone: 740-253-5981
  • Fax:
Mailing address:
  • Phone: 740-253-5981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.334809
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: