Healthcare Provider Details

I. General information

NPI: 1053165183
Provider Name (Legal Business Name): SALLY JURGENSMEYER APRN WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 W STATE HIGHWAY J
OZARK MO
65721-7425
US

IV. Provider business mailing address

1255 E WAYLAND ST
SPRINGFIELD MO
65804-3167
US

V. Phone/Fax

Practice location:
  • Phone: 417-485-5700
  • Fax:
Mailing address:
  • Phone: 417-619-2369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number2024013578
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2024013578
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: