MEDICARE: MARTA HAILU KIFLE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	53-81591-091	KS
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	2022035981	MO

General Provider Information

NPI Number	:	1891402350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTA HAILU KIFLE NP

Provider Business Mailing Address
First Line	:	8613 NW 85TH TER
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64153-1600
Country	:	US
Telephone Number	:	816-673-6697
Fax Number	:

Provider Business Practice Location Address
First Line	:	4429 S RIVER BLVD
Second Line	:
City	:	INDEPENDENCE
State	:	MO
Zip	:	64055-4659
Country	:	US
Telephone Number	:	816-768-0090
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2022
Last Update Date	:	01/17/2025

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