Provider Demographics
NPI:1033126503
Name:HOFFMAN, KELLY J (NP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:J
Last Name:HOFFMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:J
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:920 BELL AVE
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:MN
Mailing Address - Zip Code:56183-9669
Mailing Address - Country:US
Mailing Address - Phone:507-274-6121
Mailing Address - Fax:507-284-5630
Practice Address - Street 1:920 BELL AVE
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:MN
Practice Address - Zip Code:56183-9669
Practice Address - Country:US
Practice Address - Phone:507-274-6121
Practice Address - Fax:507-284-5630
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR109056-9363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN500000780Medicare PIN
MN500013513Medicare PIN
MN500019860Medicare PIN