Individual
KACEE RIDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
350 SUNNY VALLEY LN, POPLAR BLUFF, MO 63901-6739
(573) 712-7808
Mailing address
350 SUNNY VALLEY LN, POPLAR BLUFF, MO 63901-6739
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
2006023219
MO
Other
Enumeration date
09/03/2019
Last updated
09/03/2019
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