Healthcare Provider Details

I. General information

NPI: 1083586622
Provider Name (Legal Business Name): RHONDA LOUISE BRAGG FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 STATE ST
MOUND CITY MO
64470-1717
US

IV. Provider business mailing address

206 E GEORGE ST
OREGON MO
64473-9687
US

V. Phone/Fax

Practice location:
  • Phone: 816-596-4006
  • Fax:
Mailing address:
  • Phone: 816-261-9580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberF02250397
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: