Healthcare Provider Details

I. General information

NPI: 1982756748
Provider Name (Legal Business Name): SUCCESS R-VI SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 09/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10341 HIGHWAY 17
SUCCESS MO
65570-9605
US

IV. Provider business mailing address

10341 HIGHWAY 17
SUCCESS MO
65570-9605
US

V. Phone/Fax

Practice location:
  • Phone: 417-967-2597
  • Fax: 417-967-5774
Mailing address:
  • Phone: 417-967-2597
  • Fax: 417-967-5774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MRS. KRISTI LYNN WILLIAMS
Title or Position: SCHOOL NURSE
Credential:
Phone: 417-273-4274