Healthcare Provider Details

I. General information

NPI: 1689578387
Provider Name (Legal Business Name): JESSICA ELIZABETH NEAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1824 S LONE PINE AVE STE C
SPRINGFIELD MO
65804-2677
US

IV. Provider business mailing address

1824 S LONE PINE AVE STE C
SPRINGFIELD MO
65804-2677
US

V. Phone/Fax

Practice location:
  • Phone: 417-233-1049
  • Fax:
Mailing address:
  • Phone: 417-233-1049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2008023053
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number2008023053
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: