Healthcare Provider Details

I. General information

NPI: 1609684398
Provider Name (Legal Business Name): MIRANDA LEIGH ALMOND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2024
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 22
DEXTER MO
63841-0022
US

IV. Provider business mailing address

PO BOX 22
DEXTER MO
63841-0022
US

V. Phone/Fax

Practice location:
  • Phone: 724-464-4863
  • Fax:
Mailing address:
  • Phone: 724-464-4863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2024046878
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2022001610
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN637529
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: