Provider Demographics
NPI:1891402350
Name:KIFLE, MARTA HAILU (NP)
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:HAILU
Last Name:KIFLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8613 NW 85TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64153-1600
Mailing Address - Country:US
Mailing Address - Phone:816-673-6697
Mailing Address - Fax:
Practice Address - Street 1:4429 S RIVER BLVD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-4659
Practice Address - Country:US
Practice Address - Phone:816-768-0090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-03
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-81591-091363LP0808X
MO2022035981363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty