Healthcare Provider Details

I. General information

NPI: 1295403202
Provider Name (Legal Business Name): VISITING NURSE ASSOCIATION OF SOUTHEAST MISSOURI INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2021
Last Update Date: 03/02/2023
Certification Date: 02/28/2023
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: 800-286-5892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

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