Healthcare Provider Details

I. General information

NPI: 1558193573
Provider Name (Legal Business Name): SANTINA DIANNE BROWN MPHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 CUMBERLAND RD
BATES CITY MO
64011-8400
US

IV. Provider business mailing address

2015 CUMBERLAND RD
BATES CITY MO
64011-8400
US

V. Phone/Fax

Practice location:
  • Phone: 816-678-5748
  • Fax:
Mailing address:
  • Phone: 816-678-5748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number2019015755
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2025045753
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: