Provider Demographics
NPI:1235406232
Name:HOPPER, MARK K
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:K
Last Name:HOPPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38351-2165
Mailing Address - Country:US
Mailing Address - Phone:731-614-0166
Mailing Address - Fax:
Practice Address - Street 1:140 MONROE AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351-2165
Practice Address - Country:US
Practice Address - Phone:731-614-0166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-19
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN51500171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications