Provider Demographics
NPI:1538542311
Name:BREDEHOEFT, CAMIAL
Entity type:Individual
Prefix:
First Name:CAMIAL
Middle Name:
Last Name:BREDEHOEFT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAMIAL
Other - Middle Name:
Other - Last Name:VAN HOET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20333 W 151ST ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7211
Mailing Address - Country:US
Mailing Address - Phone:913-791-4357
Mailing Address - Fax:
Practice Address - Street 1:20333 W 151ST ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7211
Practice Address - Country:US
Practice Address - Phone:913-791-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2023-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016009248363A00000X
KS15-01809363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant