Healthcare Provider Details

I. General information

NPI: 1912916875
Provider Name (Legal Business Name): LINDA SUE MORTON R.D.,L.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 E.MAIN ST. BRANSON DRUG,
BRANSON MO
65616-2713
US

IV. Provider business mailing address

700 VALLEY VIEW DR
BRANSON MO
65616-2370
US

V. Phone/Fax

Practice location:
  • Phone: 417-334-3187
  • Fax: 417-334-3309
Mailing address:
  • Phone: 417-334-7118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number20010008561
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: