Provider Demographics
NPI:1275373789
Name:ANGELA S HOCKER
Entity type:Organization
Organization Name:ANGELA S HOCKER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-314-2912
Mailing Address - Street 1:602 BROOKSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5565
Mailing Address - Country:US
Mailing Address - Phone:502-314-2912
Mailing Address - Fax:
Practice Address - Street 1:602 BROOKSTONE WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-5565
Practice Address - Country:US
Practice Address - Phone:502-314-2912
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-31
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty