1245127232 NPI number — MS. KAYLA RICHELLE LEE VAN HOOSEAR

Table of content: MS. KAYLA RICHELLE LEE VAN HOOSEAR (NPI 1245127232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245127232 NPI number — MS. KAYLA RICHELLE LEE VAN HOOSEAR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAN HOOSEAR
Provider First Name:
KAYLA
Provider Middle Name:
RICHELLE LEE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SALINAS
Provider Other First Name:
KAYLA
Provider Other Middle Name:
RICHELLE LEE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1245127232
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1649 61ST ST FL 3013
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11204-2110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1924 E 32ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSBLUFF
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
69361-1870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-641-2692
Provider Business Practice Location Address Fax Number:
308-641-2692
Provider Enumeration Date:
06/21/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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