Divine Redemption LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

DIVINE REDEMPTION LLC

Practice address

112 W Broadway
Suite a
Bolivar, MO 65613

Phone

(417) 296-4140

Fax

(417) 326-0022

NPI assigned

Apr 1, 2024

Organization subpart

No

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

Authorized official

Name

Brandy Divine, DNP

Title

Owner

Phone

(417) 296-4140

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1711929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711929600000",
    "number": "1790536142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16105 S HIGHWAY 39",
            "city": "STOCKTON",
            "state": "MO",
            "postal_code": "657858391",
            "telephone_number": "417-296-4140",
            "fax_number": "417-326-0022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 W BROADWAY",
            "address_2": "SUITE A",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "65613",
            "telephone_number": "417-296-4140",
            "fax_number": "417-326-0022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE REDEMPTION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-01",
        "last_updated": "2024-04-01",
        "certification_date": "2024-03-28",
        "status": "A",
        "authorized_official_last_name": "DIVINE",
        "authorized_official_first_name": "BRANDY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "417-296-4140",
        "authorized_official_credential": "DNP"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Scott Leslie Dennis, PA
• Brandt Derrickson, ATC
• Audri Detlor, LMSW
• Dylan R Detlor, PHARMD
• Misty Ann Divin, L.P.C.
• Doctors Hearing Center LLC Xiii
• Harley Domby, PMHNP-BC
• Donald Kratz MD LLC
• Donald Kratz MD LLC
• William S Donnell Jr., M.D.

• Family Nurse Practitioner in Bolivar, MO
• Providers in Bolivar, 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 Apr 1, 2024; 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.