Healthcare Provider Details

I. General information

NPI: 1942705009
Provider Name (Legal Business Name): KAYLA HOVER RDN/LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 05/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 DENA DR
EDMOND OK
73003-3760
US

IV. Provider business mailing address

6009 W PARKER RD # 149-805
PLANO TX
75093-8120
US

V. Phone/Fax

Practice location:
  • Phone: 469-706-0404
  • Fax:
Mailing address:
  • Phone: 469-706-0404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number1965
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT85748
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: