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Brandy Divine, FNP
Family Nurse Practitioner in Kirksville, Missouri
NPI 1457803363

Brandy Divine is a Family Nurse Practitioner based in Saint Charles, MO and is specialized in Family. Brandy Divine practices in Kirksville, MO and has the professional credentials of FNP. The NPI Number for Brandy Divine is 1457803363 and holds a License No. 2016037534 (Missouri).

The current practice location address for Brandy Divine is 900 E Laharpe St, Kirksville, MO and can be reached out via phone at 660-665-1962.

Location: 900 E Laharpe St, Kirksville, MO, 63303-4120
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1457803363
Provider Name
Brandy Divine
Credential
FNP
Provider Entity Type
Individual
Gender
Female
Address
900 E Laharpe St, Kirksville, MO, 63303-4120
Phone Number
660-665-1962
Fax Number
Provider Enumeration Date
10/26/2016
Last Update Date
07/20/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1457803363 05 MO
institution
Provider Business Practice Location Address Details
Address
900 E Laharpe St
City
Kirksville
State
Missouri
Zip
63501-4520
Phone Number
660-665-1962
Fax Number
person
Provider Business Mailing Address Details
Address
900 E Laharpe St
City
Kirksville
State
Missouri
Zip
63501-4520
Phone Number
660-665-1962
Fax Number
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Family
Taxonomy
363LF0000X
License No.
2016037534 (Missouri)
Definition
Definition to come...
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