Most Relevant Information
Provider Data
| NPI Number: | 1003436411 |
| Provider Name: | KELLY L. FOURNIER CPM |
| Entity Type: | Individual |
| Taxonomy Code: | 176B00000X |
| Specialty: | Midwife |
| License Number: | 20020019 |
Most Important Dates
| Enumeration Date: | 04/26/2020 |
| Last Updated: | 04/26/2020 |
Provider Practice Location
105 S SMALLEY ST
NIXA
MO
657147829
Practice Location Phone/Fax
| Phone: | 9312090771 |
| Fax: |
Provider Mailing Location
105 S SMALLEY ST
NIXA
MO
657147829
Provider Mailing Phone/Fax
| Phone: | 9312090771 |
| Fax: |