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DIVINE REDEMPTION LLC
NPI 1790536142
Nurse Practitioner - Family in Bolivar, MO

Active since April 01, 2024
112 W BROADWAY, SUITE A, BOLIVAR, MO 65613(417) 296-4140(417) 326-0022 Get Directions Write a Review

NPPES record last updated: April 1, 2024. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Divine Redemption Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DIVINE REDEMPTION LLC (NPI 1790536142) is a healthcare organization registered as a family in Bolivar, Missouri and active in the NPI registry since April 2024. The organization lists Brandy Divine, Owner, as its authorized official.

NPPES Registry Identity

NPI1790536142
Entity TypeOrganization
Primary Taxonomy363LF0000X
Legal Business NameDIVINE REDEMPTION LLC
Location Address112 W BROADWAY, SUITE ABolivar, MO 65613
Mailing Address16105 S Highway 39Stockton, MO 65785-8391 · (417) 296-4140 · Fax (417) 326-0022
Phone(417) 296-4140
Fax(417) 326-0022
Organization SubpartNo
Authorized OfficialBrandy DivineOwner · (417) 296-4140
Enumeration DateApril 1, 2024
NPPES CertifiedMarch 28, 2024
✔ NPI 1790536142 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
Also ListedFamily Medicine · Addiction MedicineTaxonomy 207QA0401X
112 W BROADWAY, Bolivar, MO 65613
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Divine Redemption LLC's NPI number?

The NPI number for Divine Redemption LLC is 1790536142. It was assigned to this organization in the NPPES registry on April 1, 2024.

Where is Divine Redemption LLC located?

Divine Redemption LLC is located at 112 W Broadway Suite A, Bolivar, MO 65613. The listed phone number is (417) 296-4140.

What is Divine Redemption LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

When was this NPI record last updated?

The NPPES record for Divine Redemption LLC was last updated on April 1, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.