Provider Demographics
NPI:1871795765
Name:HOOVER, STEPHANIE A (PA-C)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:A
Last Name:HOOVER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:A
Other - Last Name:LATTERNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:202 COVE FORGE ROAD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16693
Mailing Address - Country:US
Mailing Address - Phone:877-297-5107
Mailing Address - Fax:
Practice Address - Street 1:202 COVE FORGE ROAD
Practice Address - Street 2:COVE FORGE BEHAVIORAL HEALTH
Practice Address - City:WILLIAMSBURG
Practice Address - State:PA
Practice Address - Zip Code:16693
Practice Address - Country:US
Practice Address - Phone:814-832-2131
Practice Address - Fax:814-832-2133
Is Sole Proprietor?:No
Enumeration Date:2007-06-03
Last Update Date:2018-03-09
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2018-03-09
Provider Licenses
StateLicense IDTaxonomies
PAMA050615L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical