Healthcare Provider Details

I. General information

NPI: 1912839523
Provider Name (Legal Business Name): PEACE VALLEY PERINATAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2026
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 COUNTY ROAD 3210
WEST PLAINS MO
65775-4930
US

IV. Provider business mailing address

6600 COUNTY ROAD 3210
WEST PLAINS MO
65775-4930
US

V. Phone/Fax

Practice location:
  • Phone: 417-596-2690
  • Fax:
Mailing address:
  • Phone: 417-596-2690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: AMELIA PROTIVA
Title or Position: DOULA
Credential: CD
Phone: 417-596-2690