Kirstie R. Recktenwald, FNP

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

2013024398 Issued in MO

Practice address

1409 Doctors Dr
West Plains, MO 65775-4754

Phone

(417) 255-1373

NPI assigned

Aug 19, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern Missouri Ear, Nose and Throat, PCGroup PAC ID 9638187131, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ozarks Healthcare Hospital, West Plains, MO, CCN 260078

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southern Missouri Ear, Nose & Throat, PC

  • Specialist
  • West Plains, MO
  • NPI 1114057395
  Medicare reassignment Care Compare group NPD
• Ozarks Medical Center

  • General Acute Care Hospital
  • West Plains, MO
  • NPI 1831115641

  Otolaryngology

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Ozarks Medical Center

  • General Acute Care Hospital
  • West Plains, MO
  • NPI 1831115641
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1376870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599696000000",
    "number": "1023441672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1409 DOCTORS DR",
            "city": "WEST PLAINS",
            "state": "MO",
            "postal_code": "657754754",
            "telephone_number": "417-255-1373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1409 DOCTORS DR",
            "city": "WEST PLAINS",
            "state": "MO",
            "postal_code": "657754754",
            "telephone_number": "417-255-1373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RECKTENWALD",
        "first_name": "KIRSTIE",
        "middle_name": "R.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-08-19",
        "last_updated": "2020-09-10",
        "certification_date": "2020-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "MO",
            "license": "2013024398",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1023441672",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bonnie Ray
• Fanny Ray, LMT
• Jessica Ray
• Anne C Ream, OPTOMETRIS
• Pam Ream
• Emily Redfearn, NP-C
• Jeremy J Reed, DO
• Joel Reed
• Melinda Renee Reed, M.D.
• Hailey Nichole Reid, RN

• Otolaryngology Physician in West Plains, MO
• Providers in West Plains, MO by specialty
• Otolaryngology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.