Healthcare Provider Details

I. General information

NPI: 1982026084
Provider Name (Legal Business Name): KELLI CHRISTINE MAYFIELD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLI CHRISTINE CROSSON NP

II. Dates (important events)

Enumeration Date: 01/09/2014
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 S. STEWART AVE
SPRINGFIELD MO
65804
US

IV. Provider business mailing address

1850 S. STEWART AVENUE
SPRINGFIELD MO
65804
US

V. Phone/Fax

Practice location:
  • Phone: 417-447-7777
  • Fax: 417-447-4099
Mailing address:
  • Phone: 816-867-4140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2014000559
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: