=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528797768
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREEM HOKETT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2022
-----------------------------------------------------
Last Update Date | 06/05/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 518 PARK ST
-----------------------------------------------------
City | DORCHESTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02124-2022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 857-237-9886
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 990115
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02199-0115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 857-237-9886
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | LN99111
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------