Individual
KATELYN BROOKE CLEOUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
2210 BARRON RD STE 120, POPLAR BLUFF, MO 63901-1922
(573) 785-6536
(573) 785-0100
Mailing address
110 S 2ND ST, ELLINGTON, MO 63638-9400
(573) 663-2313
(573) 663-2441
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2016025481
MO
2084P0800X
Psychiatry Physician
2020033726
MO
363LF0000X
Family Nurse Practitioner
Primary
2020033726
MO
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
2020033726
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
420091370
—
MO
Enumeration date
12/14/2020
Last updated
06/06/2026
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