Provider Demographics
NPI:1306192364
Name:HOOPER, MARCI ELIZABETH (BS)
Entity Type:Individual
Prefix:
First Name:MARCI
Middle Name:ELIZABETH
Last Name:HOOPER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9609 S BULLARD CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:TISHOMINGO
Mailing Address - State:OK
Mailing Address - Zip Code:73460-4000
Mailing Address - Country:US
Mailing Address - Phone:580-579-2619
Mailing Address - Fax:
Practice Address - Street 1:9609 S BULLARD CHAPEL RD
Practice Address - Street 2:
Practice Address - City:TISHOMINGO
Practice Address - State:OK
Practice Address - Zip Code:73460-4000
Practice Address - Country:US
Practice Address - Phone:580-579-2619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor