Healthcare Provider Details

I. General information

NPI: 1609787456
Provider Name (Legal Business Name): BRANCH AND BLOOM PSYCHIATRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2441 MYRA DR # 11
CAPE GIRARDEAU MO
63703-5803
US

IV. Provider business mailing address

2441 MYRA DR # 11
CAPE GIRARDEAU MO
63703-5803
US

V. Phone/Fax

Practice location:
  • Phone: 573-573-5203
  • Fax: 573-908-7839
Mailing address:
  • Phone: 573-573-5203
  • Fax: 573-908-7839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. KIMBERLY TUNELL HABER
Title or Position: FOUNDER/OWNER/AUTHORIZED OFFICIAL
Credential: PMHNP-BC
Phone: 573-520-3484