Healthcare Provider Details

I. General information

NPI: 1831835768
Provider Name (Legal Business Name): ANDREA ELIZABETH PELATE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2022
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 S JEFFERSON ST
NEOSHO MO
64850-1769
US

IV. Provider business mailing address

2127 S RHODE ISLAND DR APT 9
JOPLIN MO
64804-6101
US

V. Phone/Fax

Practice location:
  • Phone: 417-455-4200
  • Fax: 417-455-4314
Mailing address:
  • Phone: 417-362-1140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2022022827
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2025019640
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: