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Individual

KATHY A DIVINE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1235 E CHEROKEE ST, SPRINGFIELD, MO 65804-2203
(417) 820-2600
Mailing address
PO BOX 505164, SAINT LOUIS, MO 63150-5164
(855) 420-7900

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
079888
MO
363LF0000X
Family Nurse Practitioner
Primary
2017003053
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
PENDING
AR
05
PENDING
MO
05
PENDING
OK
Enumeration date
11/23/2016
Last updated
02/03/2017
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