Provider Demographics
NPI:1164530598
Name:HOVER, MARY RUSH (RD)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:RUSH
Last Name:HOVER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8517 N. SHOAL CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64157
Mailing Address - Country:US
Mailing Address - Phone:816-429-7874
Mailing Address - Fax:
Practice Address - Street 1:8517 N SHOAL CREEK PKWY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64157-6225
Practice Address - Country:US
Practice Address - Phone:816-429-7874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-27
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008028393133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered