Basic Information
Provider Information
NPI: 1013454776
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOYT
FirstName: KATHRYN
MiddleName: CONRAD
NamePrefix: MS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2331 FRANKLIN RD SW
Address2:  
City: ROANOKE
State: VA
PostalCode: 240141111
CountryCode: US
TelephoneNumber: 5407251226
FaxNumber: 5408575306
Practice Location
Address1: 2331 FRANKLIN RD SW
Address2:  
City: ROANOKE
State: VA
PostalCode: 240141111
CountryCode: US
TelephoneNumber: 5407251226
FaxNumber: 5408575306
Other Information
ProviderEnumerationDate: 01/19/2017
LastUpdateDate: 01/19/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AS0400X0110005615VAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical

No ID Information.


Home