Provider Demographics
NPI:1548511207
Name:HOOVER, RYAN LLOYD (PA-C)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:LLOYD
Last Name:HOOVER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2604 MEDICAL OFFICE PL
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9417
Mailing Address - Country:US
Mailing Address - Phone:919-580-0004
Mailing Address - Fax:919-580-9099
Practice Address - Street 1:1100 E ASH ST
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-5102
Practice Address - Country:US
Practice Address - Phone:800-243-0566
Practice Address - Fax:252-243-1347
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1003801363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8102832Medicaid
1548511207OtherNPI
NC8102832Medicaid