Healthcare Provider Details

I. General information

NPI: 1104627066
Provider Name (Legal Business Name): KENDRA L HARRALSTON APRN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 US-60
MOUNTAIN VIEW MO
65548
US

IV. Provider business mailing address

3024 COUNTY ROAD 328
THAYER MO
65791-8664
US

V. Phone/Fax

Practice location:
  • Phone: 417-934-7000
  • Fax:
Mailing address:
  • Phone: 417-293-6012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2025008804
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: