Healthcare Provider Details

I. General information

NPI: 1285567016
Provider Name (Legal Business Name): CORALEE PRETTYMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 SERENITY BAY DR
LINN CREEK MO
65052-9663
US

IV. Provider business mailing address

204 SERENITY BAY DR
LINN CREEK MO
65052-9663
US

V. Phone/Fax

Practice location:
  • Phone: 573-480-8950
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2026024240
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: