Healthcare Provider Details

I. General information

NPI: 1114672599
Provider Name (Legal Business Name): EMPOWERME NP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2022
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 E BATES
SPRINGFIELD MO
65804-8425
US

IV. Provider business mailing address

PO BOX 736522
DALLAS TX
75373-6522
US

V. Phone/Fax

Practice location:
  • Phone: 844-502-7996
  • Fax:
Mailing address:
  • Phone: 844-502-7996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOHN DAVID CHURCH
Title or Position: VICE PRESIDENT OF FINANCE
Credential:
Phone: 618-972-5228