Healthcare Provider Details

I. General information

NPI: 1629832506
Provider Name (Legal Business Name): KARINA PUENT MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 02/12/2024
Certification Date: 02/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 S NATIONAL AVE
SPRINGFIELD MO
65807-5210
US

IV. Provider business mailing address

5330 S MICHIGAN AVE APT C103
SPRINGFIELD MO
65810-2986
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-6891
  • Fax:
Mailing address:
  • Phone: 608-799-0413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: