Healthcare Provider Details

I. General information

NPI: 1700635208
Provider Name (Legal Business Name): KAITLYN DINWIDDIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2024
Last Update Date: 05/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 WASHINGTON ST
CHILLICOTHEE MO
64601-2521
US

IV. Provider business mailing address

409 WASHINGTON ST
CHILLICOTHEE MO
64601-2521
US

V. Phone/Fax

Practice location:
  • Phone: 660-665-9114
  • Fax: 573-756-0505
Mailing address:
  • Phone: 660-665-9114
  • Fax: 573-756-0505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: