=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326438961
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA D BREITZIG MSN, FPMHNP, PMH-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2015
-----------------------------------------------------
Last Update Date | 11/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3401 BERRYWOOD DR STE 300
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65201-6515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-777-8330
-----------------------------------------------------
Fax | 573-777-8390
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2885 W BATTLEFIELD ST
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65807-3952
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-761-5000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 2018012105
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 2018009437
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------