Healthcare Provider Details

I. General information

NPI: 1861201295
Provider Name (Legal Business Name): KATY DUTTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2024
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CENTER ST
EXETER MO
65647-9143
US

IV. Provider business mailing address

300 CENTER ST
EXETER MO
65647-9143
US

V. Phone/Fax

Practice location:
  • Phone: 417-342-9105
  • Fax:
Mailing address:
  • Phone: 417-342-9105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number2020006072
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: