Provider Demographics
NPI:1346433810
Name:HOOVER, AMY SUE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:SUE
Last Name:HOOVER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
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Mailing Address - Street 1:3095 DAYTON XENIA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45434-4310
Mailing Address - Country:US
Mailing Address - Phone:937-531-7902
Mailing Address - Fax:937-531-7904
Practice Address - Street 1:7073 CLYO ROAD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458
Practice Address - Country:US
Practice Address - Phone:937-435-5857
Practice Address - Fax:937-912-4960
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-19
Last Update Date:2021-01-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OHRN293009NP09523363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2875358Medicaid
OHHONP27826Medicare PIN