| Bright Sky Nutrition, Llc | |
|
3543 S Lone Pine Ave Springfield MO 65804-4854 | |
| (417) 343-8222 | |
| (866) 542-3416 |
| Full Name | Bright Sky Nutrition, Llc |
|---|---|
| Speciality | Clinic/center |
| Location | 3543 S Lone Pine Ave, Springfield, Missouri |
| Authorized Official Name and Position | Ladonna Marie Webb (OWNER/DIETITIAN) |
| Authorized Official Contact | 4173438222 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bright Sky Nutrition, Llc 3243 W Katella Ct Springfield MO 65807-8713 Ph: (417) 343-8222 | Bright Sky Nutrition, Llc 3543 S Lone Pine Ave Springfield MO 65804-4854 Ph: (417) 343-8222 |
| NPI Number | 1124477104 |
|---|---|
| Provider Enumeration Date | 06/09/2016 |
| Last Update Date | 07/06/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124477104 | NPI | - | NPPES |
| 1073807384 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 2004029834 (Missouri) | Primary |
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