Healthcare Provider Details

I. General information

NPI: 1306791603
Provider Name (Legal Business Name): LAURA M VANDENBERGHE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SKAGGS RD STE 302
BRANSON MO
65616-2062
US

IV. Provider business mailing address

101 SKAGGS RD STE 302
BRANSON MO
65616-2062
US

V. Phone/Fax

Practice location:
  • Phone: 417-334-8288
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number2026011838
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: