Healthcare Provider Details

I. General information

NPI: 1972366524
Provider Name (Legal Business Name): KAISHA RENEE HOOPER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25014 E MISSION RD
WALKER MO
64790-8449
US

IV. Provider business mailing address

322 E HOSPITAL RD
EL DORADO SPRINGS MO
64744-2022
US

V. Phone/Fax

Practice location:
  • Phone: 417-296-2821
  • Fax:
Mailing address:
  • Phone: 417-876-2118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2024003383
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: