Provider Demographics
NPI:1245664390
Name:HOFFERT, JENIFER KELLI (PA)
Entity type:Individual
Prefix:MISS
First Name:JENIFER
Middle Name:KELLI
Last Name:HOFFERT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JENIFER
Other - Middle Name:KELLI
Other - Last Name:HART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1220 W GRETNA RD
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:VA
Mailing Address - Zip Code:24557-4087
Mailing Address - Country:US
Mailing Address - Phone:434-656-1274
Mailing Address - Fax:
Practice Address - Street 1:1220 W GRETNA RD
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:VA
Practice Address - Zip Code:24557-4087
Practice Address - Country:US
Practice Address - Phone:434-656-1274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-004336363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant