Healthcare Provider Details

I. General information

NPI: 1386836989
Provider Name (Legal Business Name): RICK KLINGENSMITH FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 03/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 S NATIONAL AVE SUITE 600
SPRINGFIELD MO
65807-5287
US

IV. Provider business mailing address

3850 S NATIONAL AVE SUITE 600
SPRINGFIELD MO
65807-5287
US

V. Phone/Fax

Practice location:
  • Phone: 417-882-4880
  • Fax: 417-882-7843
Mailing address:
  • Phone: 417-882-4880
  • Fax: 417-882-7843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF0307020
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: