Healthcare Provider Details

I. General information

NPI: 1992252852
Provider Name (Legal Business Name): SARA B. MCCALLEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 US HIGHWAY 60 W
REPUBLIC MO
65738-1432
US

IV. Provider business mailing address

281 US HIGHWAY 60 W
REPUBLIC MO
65738-1432
US

V. Phone/Fax

Practice location:
  • Phone: 417-501-9042
  • Fax: 417-708-0815
Mailing address:
  • Phone: 417-501-9042
  • Fax: 417-708-0815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06170002
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2013023603
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2017017451
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: