Healthcare Provider Details

I. General information

NPI: 1740117233
Provider Name (Legal Business Name): BREANNA CLINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 E CHEROKEE ST
SPRINGFIELD MO
65804-2203
US

IV. Provider business mailing address

388 W MADRID ST
REPUBLIC MO
65738-7403
US

V. Phone/Fax

Practice location:
  • Phone: 636-667-2518
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2023023259
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: