Organization
DIVINE REDEMPTION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRANDY DIVINE DNP (OWNER)
(417) 296-4140
Entity
Organization
Contact information
Practice address
112 W BROADWAY, SUITE A, BOLIVAR, MO 65613
(417) 296-4140
(417) 326-0022
Mailing address
16105 S HIGHWAY 39, STOCKTON, MO 65785-8391
(417) 296-4140
(417) 326-0022
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
04/01/2024
Last updated
04/01/2024
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