Healthcare Provider Details

I. General information

NPI: 1831979541
Provider Name (Legal Business Name): KATIE LYNN PRICE DNP, APRN, ACCNS-AG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 10/02/2023
Certification Date: 09/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 S NATIONAL AVE
SPRINGFIELD MO
65807-5210
US

IV. Provider business mailing address

230 DONNALEE AVE
LEBANON MO
65536-2530
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-3000
  • Fax:
Mailing address:
  • Phone: 417-288-2088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number2023038566
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: