Healthcare Provider Details

I. General information

NPI: 1508775792
Provider Name (Legal Business Name): DLK MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4457 S FARM ROAD 145
SPRINGFIELD MO
65810-1414
US

IV. Provider business mailing address

4457 S FARM ROAD 145
SPRINGFIELD MO
65810-1414
US

V. Phone/Fax

Practice location:
  • Phone: 417-830-4701
  • Fax: 855-807-2451
Mailing address:
  • Phone: 417-830-4701
  • Fax: 855-807-2451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DEATRICE KELLOGG
Title or Position: OWNER/PROVIDER
Credential: MD
Phone: 417-803-4701