Healthcare Provider Details

I. General information

NPI: 1508300617
Provider Name (Legal Business Name): KELLI HOFF RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2016
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E 6TH ST
MCLAUGHLIN SD
57642-0879
US

IV. Provider business mailing address

PO BOX 879 701 E 6TH ST
MC LAUGHLIN SD
57642-0879
US

V. Phone/Fax

Practice location:
  • Phone: 605-823-4458
  • Fax: 605-823-4470
Mailing address:
  • Phone: 605-823-4458
  • Fax: 605-823-4470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR047312
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: