Provider Demographics
NPI:1356042964
Name:HOBSON, KYLA ASHLEY (FNP)
Entity type:Individual
Prefix:
First Name:KYLA
Middle Name:ASHLEY
Last Name:HOBSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 MARTIN SPRINGS DR STE 210
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-3028
Mailing Address - Country:US
Mailing Address - Phone:573-458-6350
Mailing Address - Fax:
Practice Address - Street 1:1605 MARTIN SPRINGS DR STE 210
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-3028
Practice Address - Country:US
Practice Address - Phone:573-458-6350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023009453363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily