Healthcare Provider Details

I. General information

NPI: 1144053018
Provider Name (Legal Business Name): KAITLYN HOOVER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2024
Last Update Date: 08/24/2024
Certification Date: 08/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4932 STONEYVIEW CT
DAYTON OH
45424-2531
US

IV. Provider business mailing address

4932 STONEYVIEW CT
DAYTON OH
45424-2531
US

V. Phone/Fax

Practice location:
  • Phone: 937-301-8080
  • Fax:
Mailing address:
  • Phone: 937-301-8080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number459142
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number459142
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number459142
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number459142
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number459142
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: