Healthcare Provider Details

I. General information

NPI: 1487275434
Provider Name (Legal Business Name): SCARLET KENNEDY DENTON CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2020
Last Update Date: 10/23/2021
Certification Date: 10/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 S VENTURA AVE STE B
SPRINGFIELD MO
65804-2700
US

IV. Provider business mailing address

961 S BARNES AVE
SPRINGFIELD MO
65802-2813
US

V. Phone/Fax

Practice location:
  • Phone: 417-233-1100
  • Fax: 417-622-4454
Mailing address:
  • Phone: 719-308-4221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number20040002
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: