Provider Demographics
NPI:1003922733
Name:HOOVER, KIM GLORIA (MD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:GLORIA
Last Name:HOOVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:510 N ELAM AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1142
Mailing Address - Country:US
Mailing Address - Phone:336-832-9800
Mailing Address - Fax:336-832-1369
Practice Address - Street 1:510 N ELAM AVE STE 301
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1142
Practice Address - Country:US
Practice Address - Phone:336-832-9800
Practice Address - Fax:336-832-1369
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC286942084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC43655OtherBLUECROSSPROVIDER#
NC43655OtherBLUECROSSPROVIDER#
NC28694OtherNC MEDICAL LICENSE#
NCBH3348895OtherDEA#