MEDICARE: KIMBERLY HOOVER RPA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	011179	NY

General Provider Information

NPI Number	:	1235188178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY HOOVER RPA-C

Provider Business Mailing Address
First Line	:	300 WEST AVE
Second Line	:
City	:	BROCKPORT
State	:	NY
Zip	:	14420-1118
Country	:	US
Telephone Number	:	585-637-3905
Fax Number	:	585-637-4990

Provider Business Practice Location Address
First Line	:	7309 SENECA RD N STE 112
Second Line	:
City	:	HORNELL
State	:	NY
Zip	:	14843-9691
Country	:	US
Telephone Number	:	607-590-2424
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	08/12/2024

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