Healthcare Provider Details

I. General information

NPI: 1235019969
Provider Name (Legal Business Name): HEPHIBAH I ENIADE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 N TWYMAN RD
INDEPENDENCE MO
64058-3212
US

IV. Provider business mailing address

5505 MING AVE STE 410
BAKERSFIELD CA
93309-9100
US

V. Phone/Fax

Practice location:
  • Phone: 816-750-1813
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2025002019
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: