Individual
BRANDY DIVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
900 E LAHARPE ST, KIRKSVILLE, MO 63501-4520
(660) 665-1962
Mailing address
1601 OLD SOUTH RIVER RD, SAINT CHARLES, MO 63303-4120
(636) 224-1210
(636) 246-1008
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2016037534
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1457803363
—
MO
Enumeration date
10/26/2016
Last updated
07/01/2024
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