Provider Demographics
NPI:1609684398
Name:ALMOND, MIRANDA LEIGH
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:LEIGH
Last Name:ALMOND
Suffix:
Gender:F
Credentials:
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 22
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MO
Mailing Address - Zip Code:63841-0022
Mailing Address - Country:US
Mailing Address - Phone:724-464-4863
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 22
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MO
Practice Address - Zip Code:63841-0022
Practice Address - Country:US
Practice Address - Phone:724-464-4863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022001610163W00000X
PARN637529163W00000X
MO2024046878363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse