MEDICARE: KAITLYN HOOVER RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0400X	Case Management Registered Nurse	459142	OH
2	163WI0500X	Infusion Therapy Registered Nurse	459142	OH
3	163WM0705X	Medical-Surgical Registered Nurse	459142	OH
4	163WW0000X	Wound Care Registered Nurse	459142	OH
5	163WH0200X	Home Health Registered Nurse	459142	OH

General Provider Information

NPI Number	:	1144053018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN HOOVER RN

Provider Business Mailing Address
First Line	:	4932 STONEYVIEW CT
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45424-2531
Country	:	US
Telephone Number	:	937-301-8080
Fax Number	:

Provider Business Practice Location Address
First Line	:	4932 STONEYVIEW CT
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45424-2531
Country	:	US
Telephone Number	:	937-301-8080
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2024
Last Update Date	:	08/24/2024

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