Provider Demographics
NPI:1508002569
Name:HOOKER, JEFFREY SCOTT
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:SCOTT
Last Name:HOOKER
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 1:295 PINEHURST AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-7052
Mailing Address - Country:US
Mailing Address - Phone:910-246-5155
Mailing Address - Fax:910-246-2324
Practice Address - Street 1:295 PINEHURST AVE STE 2
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-7052
Practice Address - Country:US
Practice Address - Phone:910-246-5155
Practice Address - Fax:910-246-2324
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-22
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC332B00000X
225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CFTS0569OtherAMERICAN BOARD FOR CERTIFICATION IN ORTHOTICS, PROSTHETICS, AND PEDORTHICS, INC.
NC7795451Medicaid