Divine Redemption LLC
Divine Redemption LLC is a healthcare organization registered as Family Nurse Practitioner in Bolivar, MO, holding Type 2 (organization) NPI 1790536142 since 2024. The authorized official on file is Brandy Divine, Owner.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1790536142 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Divine Redemption LLC |
| Practice address | 112 W BROADWAY, SUITE A, Bolivar, MO, 65613 |
| Phone | 4172964140 |
| Fax | 4173260022 |
| Enumeration date | 2024-04-01 |
| Last updated in NPPES | 2024-04-01 |
Authorized official
| Name | Brandy Divine |
|---|---|
| Title | Owner |
| Phone | 4172964140 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 207QA0401X | Addiction Medicine (Family Medicine) Physician | Secondary | — | — |
| 363LF0000X | Family Nurse Practitioner | Primary | — | — |
Copy-ready billing details
Provider: Divine Redemption LLC NPI: 1790536142 Taxonomy: 363LF0000X (Family Nurse Practitioner) Address: 112 W BROADWAY, SUITE A, Bolivar, MO, 65613
Verify this record
Cross-check NPI 1790536142 against the authoritative CMS record: view Divine Redemption LLC on the official NPPES registry .
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.
Frequently asked questions
What is a Type 2 NPI?
What type of organization is Divine Redemption LLC?
Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2024-04-01.