Basic Information
Provider Information
NPI: 1134794274
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOOD
FirstName: KATIE
MiddleName: LYNN
NamePrefix:  
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4580 STEPHENS CIR NW STE 202
Address2:  
City: CANTON
State: OH
PostalCode: 447183645
CountryCode: US
TelephoneNumber: 3305972815
FaxNumber:  
Practice Location
Address1: 4580 STEPHENS CIR NW STE 202
Address2:  
City: CANTON
State: OH
PostalCode: 447183645
CountryCode: US
TelephoneNumber: 3307544431
FaxNumber: 3302448839
Other Information
ProviderEnumerationDate: 05/21/2021
LastUpdateDate: 10/27/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/27/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAPRN.CNP.0028698OHY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


Home