=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831835768
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREA ELIZABETH PELATE MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2022
-----------------------------------------------------
Last Update Date | 07/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 336 S JEFFERSON ST
-----------------------------------------------------
City | NEOSHO
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64850-1769
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-455-4200
-----------------------------------------------------
Fax | 417-455-4314
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2127 S RHODE ISLAND DR APT 9
-----------------------------------------------------
City | JOPLIN
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64804-6101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-362-1140
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number | 2022022827
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 2025019640
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------