Provider Demographics
NPI:1366766917
Name:HOOPER, DAVID AUSTIN (PA-C)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:AUSTIN
Last Name:HOOPER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64525
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-0525
Mailing Address - Country:US
Mailing Address - Phone:910-483-2556
Mailing Address - Fax:910-483-8756
Practice Address - Street 1:2301 ROBESON ST
Practice Address - Street 2:SUITE 202
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5640
Practice Address - Country:US
Practice Address - Phone:910-483-2556
Practice Address - Fax:910-483-8756
Is Sole Proprietor?:No
Enumeration Date:2010-03-24
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02256363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCE143AMedicare PIN