Kaylee Jaynelle Ankrom
Individual provider Active NPI Family Nurse Practitioner · Bolivar, MO
NPI 1104474741 · NPPES record last updated Nov 27, 2019
Key facts
- NPI
- 1104474741
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 2019032011 (MO)
- Practice address
- 1300 N Oakland Ave
Bolivar, MO 65613-3018 - Phone
- (417) 326-7676
- NPI assigned
- Aug 27, 2019
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20191104000053 | MO | Practitioner - Nurse Practitioner | 6406188994 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2019032011 | MO | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Citizens Memorial Healthcare | Current |
Accepting new patients | |
| Citizens Memorial Healthcare | Current |
Accepting new patients |
Locations
1300 N Oakland Ave
Bolivar, MO 65613
Phone (417) 326-7676
1500 N Oakland Ave
Bolivar, MO 65613
Phone (417) 326-6000
502 S Miller Rd
Willard, MO 65781
Phone (417) 761-6655
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 2019032011 | MO | Yes |
Addresses
Primary practice location
1300 N Oakland Ave
Bolivar, MO 65613-3018
Mailing address
1300 N Oakland Ave
Bolivar, MO 65613-3018
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | kaylee.ankrom@citizensmemorial.com | Direct |
Other providers in Bolivar, MO
- Sandra A Allan
- Seth Daniel Alley
- Alpha-Omega Orthotics & Prosthetics, Inc.
- Rebecca Ruth Alumbaugh
- Debra Ann Anderson
- Nadia Ariqat
- Hannah Ashlock
- Associates in Medicine
- Associates in Medicine, Inc
- Stephanie Marie Aug
All providers in Bolivar, MO · Family Nurse Practitioner in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 27, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.