Provider Demographics
NPI:1598156820
Name:HOOPER, LAURA (AGNP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:HOOPER
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15945 CLAYTON RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2490
Mailing Address - Country:US
Mailing Address - Phone:636-256-5000
Mailing Address - Fax:636-256-5042
Practice Address - Street 1:15945 CLAYTON RD
Practice Address - Street 2:SUITE 120
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-2490
Practice Address - Country:US
Practice Address - Phone:636-256-5000
Practice Address - Fax:636-256-5042
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005025456363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology