Provider Demographics
NPI:1184625527
Name:HOOVER, DARLENE K (PA-C)
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:K
Last Name:HOOVER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10215 AUBURN PARK DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-2387
Mailing Address - Country:US
Mailing Address - Phone:260-490-4673
Mailing Address - Fax:260-490-2165
Practice Address - Street 1:10215 AUBURN PARK DR
Practice Address - Street 2:SUITE B
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-2387
Practice Address - Country:US
Practice Address - Phone:260-490-4673
Practice Address - Fax:260-490-2165
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000449A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN248410BMedicare PIN
INP14596Medicare UPIN