Provider Demographics
NPI:1184821654
Name:BADGER, KASONDRA (LPN)
Entity Type:Individual
Prefix:
First Name:KASONDRA
Middle Name:
Last Name:BADGER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 396
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65556-0396
Mailing Address - Country:US
Mailing Address - Phone:417-532-3495
Mailing Address - Fax:417-532-3598
Practice Address - Street 1:874 S JEFFERSON
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536
Practice Address - Country:US
Practice Address - Phone:417-532-3495
Practice Address - Fax:417-532-3598
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006006060164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse