Provider Demographics
NPI:1497332985
Name:HOPSON, KENTTICA
Entity Type:Individual
Prefix:
First Name:KENTTICA
Middle Name:
Last Name:HOPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 PLANK RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23868-1719
Mailing Address - Country:US
Mailing Address - Phone:434-378-0879
Mailing Address - Fax:
Practice Address - Street 1:416 PLANK RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:VA
Practice Address - Zip Code:23868-1719
Practice Address - Country:US
Practice Address - Phone:434-378-0879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No347E00000XTransportation ServicesTransportation Broker
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)