Healthcare Provider Details

I. General information

NPI: 1164790465
Provider Name (Legal Business Name): CENTRAL MISSOURI HEALTHCARE ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 BINGHAM RD
BOONVILLE MO
65233-2229
US

IV. Provider business mailing address

1417 BINGHAM RD
BOONVILLE MO
65233-2229
US

V. Phone/Fax

Practice location:
  • Phone: 660-882-8018
  • Fax: 660-882-3188
Mailing address:
  • Phone: 660-882-8018
  • Fax: 660-882-3188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number116825
License Number StateMO

VIII. Authorized Official

Name: KATHLEEN G LENZ
Title or Position: PRESIDENT
Credential: DNP
Phone: 660-882-8018