Healthcare Provider Details

I. General information

NPI: 1477106276
Provider Name (Legal Business Name): KAYLA ANN HOFFMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAYLA ANN MCCRITE

II. Dates (important events)

Enumeration Date: 07/20/2019
Last Update Date: 07/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 NW MONTEBELLA DR
RIVERSIDE MO
64150-7824
US

IV. Provider business mailing address

1201 TULLISON RD
KANSAS CITY MO
64116-2639
US

V. Phone/Fax

Practice location:
  • Phone: 785-608-8396
  • Fax:
Mailing address:
  • Phone: 785-608-8396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2011003303
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: