=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982447702
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RIVERBRANCH HEALTHCARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2024
-----------------------------------------------------
Last Update Date | 10/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 281 US HIGHWAY 60 W
-----------------------------------------------------
City | REPUBLIC
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65738-1432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-501-9042
-----------------------------------------------------
Fax | 417-708-0815
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 281 US HIGHWAY 60 W
-----------------------------------------------------
City | REPUBLIC
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65738-1432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-501-9042
-----------------------------------------------------
Fax | 417-708-0815
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FNP-C/OWNER
-----------------------------------------------------
Name | SARA B. MCCALLEY
-----------------------------------------------------
Credential | FNP-C
-----------------------------------------------------
Telephone | 417-501-9042
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------