Healthcare Provider Details

I. General information

NPI: 1811630494
Provider Name (Legal Business Name): STEPHANIE NICOLE O'HALLORAN-WILKERSON PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 E SEMINOLE ST
SPRINGFIELD MO
65804-2490
US

IV. Provider business mailing address

1675 E SEMINOLE ST
SPRINGFIELD MO
65804-2490
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2022008045
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: