Provider Demographics
NPI:1013660778
Name:HOOCK, KELLY JEAN (MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:JEAN
Last Name:HOOCK
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 MEADOWLARK LN SE STE 2
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1050
Mailing Address - Country:US
Mailing Address - Phone:505-994-3256
Mailing Address - Fax:
Practice Address - Street 1:4200 MEADOWLARK LN SE STE 2
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1050
Practice Address - Country:US
Practice Address - Phone:505-994-3256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM66854363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM07487088Medicaid