Healthcare Provider Details

I. General information

NPI: 1609789262
Provider Name (Legal Business Name): KANDICE J EATON BSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S ASH ST
NEVADA MO
64772-3223
US

IV. Provider business mailing address

2565 KANSAS RD
FORT SCOTT KS
66701
US

V. Phone/Fax

Practice location:
  • Phone: 417-667-3355
  • Fax:
Mailing address:
  • Phone: 620-644-8055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: