Healthcare Provider Details

I. General information

NPI: 1396133260
Provider Name (Legal Business Name): KACI O'NEILL MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KACI PRICE

II. Dates (important events)

Enumeration Date: 12/31/2014
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 OAK GROVE RD
POPLAR BLUFF MO
63901-1573
US

IV. Provider business mailing address

PO BOX 1308
POPLAR BLUFF MO
63902-1308
US

V. Phone/Fax

Practice location:
  • Phone: 573-776-9699
  • Fax: 573-776-9607
Mailing address:
  • Phone: 573-843-8380
  • Fax: 573-843-8381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2010002706
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2015002154
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: