Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 20020019 |
NPI | 1003436411 |
---|---|
Provider Name | Kelly L. Fournier |
First Address | Nixa, MO 65714-7829 |
Second Address | Nixa, MO 65714-7829 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2020 |
Last Update Date | 26/04/2020 |