Kathy A Divine

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

2017003053 Issued in MO

Practice address

1235 E Cherokee St
Springfield, MO 65804-2203

Phone

(417) 820-2600

NPI assigned

Nov 23, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1479859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486080000000",
    "number": "1730622705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 505164",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631505164",
            "telephone_number": "855-420-7900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1235 E CHEROKEE ST",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658042203",
            "telephone_number": "417-820-2600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIVINE",
        "first_name": "KATHY",
        "middle_name": "A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-23",
        "last_updated": "2017-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MO",
            "license": "079888",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2017003053",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Russell T Dirksen, D.P.M.
• Discover Audiology, LLC
• Jonathan Distaulo, PLPC
• Kristi Ditzfeld, LPC, NCC
• Divergent Behavioral Services LLC
• Linda Marie Divine
• Tarrah Divine, FNP
• Anthony R Divito, MD
• Patricia Mary Dix, M.D.
• Staci E Dixon, DO

• Family Nurse Practitioner in Springfield, MO
• Providers in Springfield, MO by specialty
• Family Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2017; 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.