Divine Redemption LLC
NPI 1790536142ActiveOrganization· Nurse Practitioner, Family· Bolivar, MO
Nurse Practitioner, Family in Bolivar, Missouri, registered in NPPES in April 2024. The authorized official on file is Brandy Divine, DNP, Owner.
Overview
| NPI | 1790536142 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Apr 1, 2024 |
| Last updated in NPPES | Apr 1, 2024 |
| Certified by provider | Mar 28, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Nurse Practitioner, Family Primary | 363LF0000X | — | — |
| Family Medicine, Addiction Medicine | 207QA0401X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
Other Nurse Practitioner, Family providers in Bolivar
- 1558019067
- 1104474741
- 1528910080
- 1164074175
- 1811712623
- 1194211664
- 1427465194
- 1528384823
- 1902577141
- 1902315401
- 1326778572
- 1043760341