Healthcare Provider Details

I. General information

NPI: 1467695304
Provider Name (Legal Business Name): DANIELA NOVOTNY RD, LD, CHES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2009
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 S NATIONAL AVE
SPRINGFIELD MO
65897-0027
US

IV. Provider business mailing address

3847 W EDGEWOOD ST
SPRINGFIELD MO
65807-5586
US

V. Phone/Fax

Practice location:
  • Phone: 417-619-8981
  • Fax:
Mailing address:
  • Phone: 417-619-8981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2006029444
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number58635
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: