Healthcare Provider Details

I. General information

NPI: 1528168689
Provider Name (Legal Business Name): LISA KAY UMFLEET RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 N DESLOGE DR
DESLOGE MO
63601-2936
US

IV. Provider business mailing address

1131 N DESLOGE DR
DESLOGE MO
63601-2936
US

V. Phone/Fax

Practice location:
  • Phone: 573-431-6777
  • Fax: 573-431-3833
Mailing address:
  • Phone: 573-431-6677
  • Fax: 573-431-3833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number21600062
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number044520
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: