Healthcare Provider Details

I. General information

NPI: 1356042964
Provider Name (Legal Business Name): KYLA ASHLEY HOBSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 MARTIN SPRINGS DR STE 210
ROLLA MO
65401-3028
US

IV. Provider business mailing address

1605 MARTIN SPRINGS DR STE 210
ROLLA MO
65401-3028
US

V. Phone/Fax

Practice location:
  • Phone: 573-458-6350
  • Fax:
Mailing address:
  • Phone: 573-458-6350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2023009453
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: