Healthcare Provider Details

I. General information

NPI: 1811356751
Provider Name (Legal Business Name): TIMOTHY KESSINGER-MCCROSKEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TIM MCCROSKEY

II. Dates (important events)

Enumeration Date: 02/21/2016
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 N JEFFERSON AVE
SPRINGFIELD MO
65802-1917
US

IV. Provider business mailing address

5439 S FARM ROAD 141
SPRINGFIELD MO
65810-2220
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-6583
  • Fax:
Mailing address:
  • Phone: 417-766-7781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2016003054
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: