Diabetes Clinicare & Wellness Springfield LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

DIABETES CLINICARE & WELLNESS SPRINGFIELD LLC

Practice address

1649 S Enterprise Ave
Springfield, MO 65804-1850

Phone

(417) 771-5266

Fax

(417) 590-8232

NPI assigned

Aug 22, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ricky Tucker

Title

Manager

Phone

(417) 413-1351

Specialties & licenses 3

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1661126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661126400000",
    "number": "1548988835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3125 S BRANDYWINE TRL",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658094304",
            "telephone_number": "417-771-5266",
            "fax_number": "417-590-8232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1649 S ENTERPRISE AVE",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658041850",
            "telephone_number": "417-771-5266",
            "fax_number": "417-590-8232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIABETES CLINICARE & WELLNESS SPRINGFIELD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-22",
        "last_updated": "2022-08-22",
        "certification_date": "2022-08-22",
        "status": "A",
        "authorized_official_last_name": "TUCKER",
        "authorized_official_first_name": "RICKY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "417-413-1351"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Kent Dexter, MD
• Prabin Dhakal, MD
• Kiran Dhaliwal, FNP-BC
• Swati Dhankikar, MD
• Harwinder K Dhanoa
• Aubrie Michelle Dial, FNP-BC
• Justine Diaz, LPC
• Megan Dible
• Terah Dick, CPHT
• Michelle R. Dickens, FNP

• Family Medicine Physician in Springfield, MO
• Providers in Springfield, MO by specialty
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.