Healthcare Provider Details

I. General information

NPI: 1013745413
Provider Name (Legal Business Name): KASEY ANN ENDRES PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 E ROGERS AVE
SPRINGFIELD MO
65804-4595
US

IV. Provider business mailing address

202 THELMA AVE
ROGERSVILLE MO
65742-9316
US

V. Phone/Fax

Practice location:
  • Phone: 417-820-2914
  • Fax:
Mailing address:
  • Phone: 417-209-8676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2024024653
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: