Provider Demographics
NPI:1073264354
Name:HOOPER NP TELE HEALTH LLC
Entity Type:Organization
Organization Name:HOOPER NP TELE HEALTH LLC
Other - Org Name:HOOPER NP TELEHEALTH LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADVANCED PRACTICE NURSE
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOPER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:940-636-4745
Mailing Address - Street 1:4856 STATE HIGHWAY 79 S
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76310-4503
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4856 STATE HIGHWAY 79 S
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76310-4503
Practice Address - Country:US
Practice Address - Phone:940-636-4745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-18
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service