Provider Demographics
NPI:1669704193
Name:HOF, KIPHANY J (PLMHP)
Entity type:Individual
Prefix:
First Name:KIPHANY
Middle Name:J
Last Name:HOF
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 AVENUE A
Mailing Address - Street 2:SUITE E
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-8169
Mailing Address - Country:US
Mailing Address - Phone:308-234-5644
Mailing Address - Fax:308-234-5652
Practice Address - Street 1:3720 AVENUE A
Practice Address - Street 2:SUITE E
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-8169
Practice Address - Country:US
Practice Address - Phone:308-234-5644
Practice Address - Fax:308-234-5652
Is Sole Proprietor?:No
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP9093101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47080829226Medicaid