Provider Demographics
NPI:1053073387
Name:HOOVER, BRYN LAUREN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:BRYN
Middle Name:LAUREN
Last Name:HOOVER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 GREEN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SCHUYLER
Mailing Address - State:VA
Mailing Address - Zip Code:22969-1501
Mailing Address - Country:US
Mailing Address - Phone:315-725-2656
Mailing Address - Fax:
Practice Address - Street 1:2010 HEALTH CAMPUS DR
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:VA
Practice Address - Zip Code:22801-8679
Practice Address - Country:US
Practice Address - Phone:540-689-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110007957363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant