Provider Demographics
NPI:1053607036
Name:HOOVER, ADAM JEREMY (CRNA)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:JEREMY
Last Name:HOOVER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 NW COTTONWOOD CT
Mailing Address - Street 2:
Mailing Address - City:GRAIN VALLEY
Mailing Address - State:MO
Mailing Address - Zip Code:64029-8365
Mailing Address - Country:US
Mailing Address - Phone:816-769-7461
Mailing Address - Fax:
Practice Address - Street 1:8717 W. 110TH ST.
Practice Address - Street 2:BLDG. 14 STE. 600
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2144
Practice Address - Country:US
Practice Address - Phone:913-428-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011019315367500000X
KS43-557024-071367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO916573306Medicaid