Healthcare Provider Details

I. General information

NPI: 1164530598
Provider Name (Legal Business Name): MARY RUSH HOVER R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2006
Last Update Date: 12/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8517 N SHOAL CREEK PKWY
KANSAS CITY MO
64157-6225
US

IV. Provider business mailing address

8517 N. SHOAL CREEK PKWY
KANSAS CITY MO
64157
US

V. Phone/Fax

Practice location:
  • Phone: 816-429-7874
  • Fax:
Mailing address:
  • Phone: 816-429-7874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2008028393
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: