Healthcare Provider Details

I. General information

NPI: 1619358306
Provider Name (Legal Business Name): KENDRA RASMUSSEN APRN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2015
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 E SEMINOLE ST STE A1
SPRINGFIELD MO
65804-2454
US

IV. Provider business mailing address

1675 E SEMINOLE ST STE A1
SPRINGFIELD MO
65804-2454
US

V. Phone/Fax

Practice location:
  • Phone: 417-557-2355
  • Fax: 417-530-1455
Mailing address:
  • Phone: 417-557-2355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2019003633
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2010018982
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: