Basic Information
| Provider Information | |||||||||
| NPI: | 1265801245 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOPSON | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | VICTORIA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | APRN-CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 313 JEFFERSON AVENUE | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192557883 | ||||||||
| FaxNumber: | 4196961529 | ||||||||
| Practice Location | |||||||||
| Address1: | 17273 STATE ROUTE 104 | ||||||||
| Address2: | |||||||||
| City: | CHILLICOTHE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456019718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407731141 | ||||||||
| FaxNumber: | 7407731141 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2015 | ||||||||
| LastUpdateDate: | 03/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WG0000X | RN.273706 | OH | N | Nursing Service Providers | Registered Nurse | General Practice | 363LG0600X | APRN.CNP.021164 | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | 363LP2300X | APRN.CNP.021164 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | CS1800300154 | 01 | OH | CARESOURCE ID | OTHER | 0242209 | 05 | OH | MEDICAID |