Healthcare Provider Details

I. General information

NPI: 1700793023
Provider Name (Legal Business Name): KATRINA ALEXANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 BRANSON LANDING BLVD
BRANSON MO
65616-2052
US

IV. Provider business mailing address

6153 NEWTON LINE RD
HARRISON AR
72601-7067
US

V. Phone/Fax

Practice location:
  • Phone: 417-335-7000
  • Fax:
Mailing address:
  • Phone: 870-302-8782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2023050158
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2449
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: