Healthcare Provider Details

I. General information

NPI: 1366634859
Provider Name (Legal Business Name): AIDS PROJECT OF THE OZARKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1636 SO. GLENSTONE, STE. 100
SPRINGFIELD MO
65804-6580
US

IV. Provider business mailing address

1636 SO. GLENSTONE, STE. 100
SPRINGFIELD MO
65804-1434
US

V. Phone/Fax

Practice location:
  • Phone: 417-881-1300
  • Fax: 417-881-1237
Mailing address:
  • Phone: 417-881-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMBER CORNELISON
Title or Position: OFFICE MANAGER
Credential:
Phone: 417-881-1900