Healthcare Provider Details

I. General information

NPI: 1265841597
Provider Name (Legal Business Name): TEHESHA S STEGALL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2014
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 S PATTERSON AVE
SPRINGFIELD MO
65802-2210
US

IV. Provider business mailing address

PO BOX 802843
KANSAS CITY MO
64180-2843
US

V. Phone/Fax

Practice location:
  • Phone: 417-829-2996
  • Fax: 417-829-2999
Mailing address:
  • Phone: 417-730-6430
  • Fax: 417-269-7567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2014025534
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: