Kaisha Renee Hooper
Individual provider Active NPI Family Nurse Practitioner · Walker, MO
NPI 1972366524 · NPPES record last updated Feb 5, 2024
Key facts
- NPI
- 1972366524
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 2024003383 (MO)
- Practice address
- 25014 E Mission Rd
Walker, MO 64790-8449 - Phone
- (417) 296-2821
- NPI assigned
- Feb 5, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240406000181 | MO | Practitioner - Nurse Practitioner | 3274971445 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Citizens Memorial Healthcare | Current |
Accepting new patients | |
| Citizens Memorial Healthcare | Current |
Accepting new patients |
Locations
1500 N Oakland Ave
Bolivar, MO 65613
Phone (417) 326-6000
322 E Hospital Rd
El Dorado Springs, MO 64744
Phone (417) 876-2118
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 2024003383 | MO | Yes |
Addresses
Primary practice location
25014 E Mission Rd
Walker, MO 64790-8449
Mailing address
322 E Hospital Rd
El Dorado Springs, MO 64744-2022
Phone (417) 876-2118
Other providers in Walker, MO
All providers in Walker, MO · Family Nurse Practitioner in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 5, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.