Healthcare Provider Details

I. General information

NPI: 1205828183
Provider Name (Legal Business Name): VISITING NURSE ASSOCIATION OF SOUTHEAST MISSOURI, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 INDEPENDENCE AVE
KENNETT MO
63857-1314
US

IV. Provider business mailing address

PO BOX 768
KENNETT MO
63857-0768
US

V. Phone/Fax

Practice location:
  • Phone: 573-888-5892
  • Fax: 573-888-0538
Mailing address:
  • Phone: 573-888-5892
  • Fax: 573-888-0538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number158-20
License Number StateMO

VIII. Authorized Official

Name: MRS. SHONDA HOLLOMON YOUNG
Title or Position: CEO
Credential:
Phone: 573-888-5892