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General NPI Number Information
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NPI Number | 1265394431
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Entity Type | Organization
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Legal Business Name | CHARIS HEALTHCARE OF MISSOURI LLC
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Dates
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Enumeration Date | 11/26/2025
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Last Update Date | 11/26/2025
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Provider Practice Location Address
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Address Line | 1815 KATELYN ST
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City | KENNETT
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State | MO
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Zip | 63857-4112
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Country | US
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Telephone | 870-489-8633
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Fax |
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Provider Business Mailing Address
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Address Line | 1815 KATELYN ST
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City | KENNETT
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State | MO
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Zip | 63857-4112
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Country | US
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Telephone | 870-489-8633
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TIFFANY MOORE
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Credential | NP
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Telephone | 870-489-8633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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