Provider Demographics
NPI:1487369757
Name:BODY BEAUTIFUL
Entity type:Organization
Organization Name:BODY BEAUTIFUL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARYA
Authorized Official - Middle Name:M
Authorized Official - Last Name:STUMP
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:660-227-6038
Mailing Address - Street 1:17 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:MO
Mailing Address - Zip Code:64730-2135
Mailing Address - Country:US
Mailing Address - Phone:660-227-6038
Mailing Address - Fax:660-227-6189
Practice Address - Street 1:17 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:MO
Practice Address - Zip Code:64730-2135
Practice Address - Country:US
Practice Address - Phone:660-227-6038
Practice Address - Fax:660-227-6189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty