Provider Demographics
NPI:1942705009
Name:HOVER, KAYLA (RDN/LD)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:HOVER
Suffix:
Gender:F
Credentials:RDN/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6009 W PARKER RD # 149-805
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8120
Mailing Address - Country:US
Mailing Address - Phone:469-706-0404
Mailing Address - Fax:
Practice Address - Street 1:1800 DENA DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-3760
Practice Address - Country:US
Practice Address - Phone:469-706-0404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1965133V00000X
TXDT85748133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered