Basic Information
| Provider Information | |||||||||
| NPI: | 1396283750 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEUNER | ||||||||
| FirstName: | KATHARYN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 N KEENE ST | ||||||||
| Address2: | SUITE 115 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652016626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738826978 | ||||||||
| FaxNumber: | 5738843991 | ||||||||
| Practice Location | |||||||||
| Address1: | 404 N KEENE ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652016626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738826921 | ||||||||
| FaxNumber: | 5738843991 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2017 | ||||||||
| LastUpdateDate: | 06/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 120719 | MO | Y | Nursing Service Providers | Registered Nurse |
ID Information
| ID | Type | State | Issuer | Description | 35AE | 05 | MO | MEDICAID |