Healthcare Provider Details

I. General information

NPI: 1740807031
Provider Name (Legal Business Name): COURTNEY R KUNZE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2020
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501A W TRUMAN BLVD
JEFFERSON CITY MO
65109-5715
US

IV. Provider business mailing address

PO BOX 843966
KANSAS CITY MO
64184-3966
US

V. Phone/Fax

Practice location:
  • Phone: 573-636-0635
  • Fax: 573-659-4685
Mailing address:
  • Phone: 573-884-3300
  • Fax: 573-884-0943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2020019809
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: