Healthcare Provider Details

I. General information

NPI: 1245152479
Provider Name (Legal Business Name): RACHELL FORDYCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3151 LITTON RD
CHILLICOTHEE MO
64601-8502
US

IV. Provider business mailing address

19790 AUSTIN DR
HARRIS MO
64645-8151
US

V. Phone/Fax

Practice location:
  • Phone: 660-646-4032
  • Fax:
Mailing address:
  • Phone: 660-292-1350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2026011545
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: