Divine Redemption LLC
Divine Redemption LLC is an Addiction Medicine (Family Medicine) Physician in Bolivar, Missouri. Registered with an NPI since 2024.
- In the registry since
- 2024
- Specialties on file
- 2
What do these letters mean?
- LLC — Limited liability company
- A form of business registration, not a clinical qualification.
Practice location Address checks out
112 W Broadway Ste ABolivar, MO 65613
Phone: (417) 296-4140
Fax: (417) 326-0022
Show map & directions
Directions in Google Maps · Apple Maps · OpenStreetMap
Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Family Nurse Practitioner (primary) | Taxonomy 363LF0000X |
|---|---|
| Addiction Medicine (Family Medicine) Physician | Taxonomy 207QA0401X |
Record details
| NPI number | 1790536142 |
|---|---|
| Entity type | Organization (Type 2) |
| Organization subpart | No |
| Authorized official | Brandy Divine — Owner · (417) 296-4140 |
| NPI enumerated | April 1, 2024 |
| Last updated in NPPES | April 1, 2024 |
| Certification date | March 28, 2024 |
| Mailing address | 16105 S Highway 39, Stockton, MO 65785-8391 |