Provider Demographics
NPI:1184778367
Name:HOOKOM, KATHYRN LYNN
Entity type:Individual
Prefix:MRS
First Name:KATHYRN
Middle Name:LYNN
Last Name:HOOKOM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 POPE STREET
Mailing Address - Street 2:
Mailing Address - City:STARBUCK
Mailing Address - State:MN
Mailing Address - Zip Code:56381
Mailing Address - Country:US
Mailing Address - Phone:320-239-4881
Mailing Address - Fax:
Practice Address - Street 1:706 POPE ST
Practice Address - Street 2:
Practice Address - City:STARBUCK
Practice Address - State:MN
Practice Address - Zip Code:56381-2387
Practice Address - Country:US
Practice Address - Phone:320-239-4881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN334364171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor