Healthcare Provider Details

I. General information

NPI: 1629429329
Provider Name (Legal Business Name): KATHERINE DOLLIE SKAGGS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2016
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 STATE HIGHWAY 248 STE 202
BRANSON MO
65616-3729
US

IV. Provider business mailing address

PO BOX 802843
KANSAS CITY MO
64180-2208
US

V. Phone/Fax

Practice location:
  • Phone: 417-348-8964
  • Fax: 417-336-0275
Mailing address:
  • Phone: 417-730-6430
  • Fax: 417-269-7567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2019016852
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: