Healthcare Provider Details

I. General information

NPI: 1225548647
Provider Name (Legal Business Name): LAURA JO HOFFERBER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURA JO COULTER

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 S 5TH ST
ENID OK
73701-5832
US

IV. Provider business mailing address

4423 E WHEAT CAPITAL RD
ENID OK
73701-8536
US

V. Phone/Fax

Practice location:
  • Phone: 580-548-5010
  • Fax: 580-548-5012
Mailing address:
  • Phone: 405-310-0836
  • Fax: 405-758-5582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number83113
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number83113
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number83113
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number83113
License Number StateOK
# 5
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number83113
License Number StateOK
# 6
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number83113
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: