Healthcare Provider Details

I. General information

NPI: 1891402350
Provider Name (Legal Business Name): MARTA HAILU KIFLE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2022
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4429 S RIVER BLVD
INDEPENDENCE MO
64055-4659
US

IV. Provider business mailing address

8613 NW 85TH TER
KANSAS CITY MO
64153-1600
US

V. Phone/Fax

Practice location:
  • Phone: 816-768-0090
  • Fax:
Mailing address:
  • Phone: 816-673-6697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number53-81591-091
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2022035981
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: