Healthcare Provider Details

I. General information

NPI: 1134738735
Provider Name (Legal Business Name): YOUR HEALTH CONSULTANT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 E WELLS ST STE B
ASH GROVE MO
65604-9087
US

IV. Provider business mailing address

609 E WELLS ST STE B
ASH GROVE MO
65604-9087
US

V. Phone/Fax

Practice location:
  • Phone: 417-234-3621
  • Fax:
Mailing address:
  • Phone: 417-234-3621
  • Fax: 949-655-7855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SUSAN MARIE KLOTZ
Title or Position: PROVIDER/OWNER
Credential: FNP-BC
Phone: 417-234-3621