Healthcare Provider Details

I. General information

NPI: 1730456013
Provider Name (Legal Business Name): KARE HEALTH & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 11/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 E BRADFORD PKWY SUITE 105
SPRINGFIELD MO
65804-6563
US

IV. Provider business mailing address

1435 E BRADFORD PKWY SUITE 105
SPRINGFIELD MO
65804-6563
US

V. Phone/Fax

Practice location:
  • Phone: 417-881-4994
  • Fax: 417-881-4998
Mailing address:
  • Phone: 417-881-4994
  • Fax: 417-881-4998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2010006173
License Number StateMO

VIII. Authorized Official

Name: MR. KERI SUTTON
Title or Position: OWNER
Credential:
Phone: 417-881-4994