Provider Demographics
NPI:1134161656
Name:HOCKENBROCHT, KENETTA E (CRNP)
Entity type:Individual
Prefix:
First Name:KENETTA
Middle Name:E
Last Name:HOCKENBROCHT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KENETTA
Other - Middle Name:E
Other - Last Name:HARSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-656-6122
Mailing Address - Fax:717-656-0142
Practice Address - Street 1:368 W MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LEOLA
Practice Address - State:PA
Practice Address - Zip Code:17540-1761
Practice Address - Country:US
Practice Address - Phone:717-656-6122
Practice Address - Fax:717-656-0142
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP0064667B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA157418FLTOtherMEDICARE
50073069OtherBLUE CROSS
001671342OtherBLUE SHIELD
PA092914Medicare UPIN
PA157418FLTOtherMEDICARE