Provider Demographics
NPI:1750833893
Name:HOBBS, KENYATTA VAN SR
Entity Type:Individual
Prefix:
First Name:KENYATTA
Middle Name:VAN
Last Name:HOBBS
Suffix:SR
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 1:305 KIROLI RD
Mailing Address - Street 2:15
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-7095
Mailing Address - Country:US
Mailing Address - Phone:318-267-1693
Mailing Address - Fax:
Practice Address - Street 1:305 KIROLI RD
Practice Address - Street 2:15
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7095
Practice Address - Country:US
Practice Address - Phone:318-267-1693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA008125645343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)