Healthcare Provider Details

I. General information

NPI: 1720945439
Provider Name (Legal Business Name): NOEL DAWN KISH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 STATE ROUTE 76 APT 24
WILLOW SPRINGS MO
65793-8256
US

IV. Provider business mailing address

2700 STATE ROUTE 76 APT 24
WILLOW SPRINGS MO
65793-8256
US

V. Phone/Fax

Practice location:
  • Phone: 844-325-8828
  • Fax:
Mailing address:
  • Phone: 844-325-8828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: