Provider Demographics
NPI:1972366524
Name:HOOPER, KAISHA RENEE
Entity Type:Individual
Prefix:
First Name:KAISHA
Middle Name:RENEE
Last Name:HOOPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 E HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:EL DORADO SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64744-2022
Mailing Address - Country:US
Mailing Address - Phone:417-876-2118
Mailing Address - Fax:
Practice Address - Street 1:25014 E MISSION RD
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:MO
Practice Address - Zip Code:64790-8449
Practice Address - Country:US
Practice Address - Phone:417-296-2821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024003383363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily