Provider Demographics
NPI:1154190015
Name:HOCKMAN, KELLY LARRICK (MSN-ED, RN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LARRICK
Last Name:HOCKMAN
Suffix:
Gender:F
Credentials:MSN-ED, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 TIMBERLAKES LN
Mailing Address - Street 2:
Mailing Address - City:CLEAR BROOK
Mailing Address - State:VA
Mailing Address - Zip Code:22624-1604
Mailing Address - Country:US
Mailing Address - Phone:540-323-3031
Mailing Address - Fax:
Practice Address - Street 1:300 FOXCROFT AVE
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-5341
Practice Address - Country:US
Practice Address - Phone:304-260-0147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001253893163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health