Rachelle Endrigan Renfro, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

2010028206 Issued in MO

Practice address

901 NE Independence Ave
Lees Summit, MO 64086-5544

Phone

(816) 581-5899

Fax

(816) 347-3046

NPI assigned

Jun 8, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mrs. Rachelle Endrigan Sticken Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1496880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1174052476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 NE INDEPENDENCE AVE",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640865544",
            "telephone_number": "816-581-5899",
            "fax_number": "816-347-3046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 NE INDEPENDENCE AVE",
            "city": "LEES SUMMIT",
            "state": "MO",
            "postal_code": "640865544",
            "telephone_number": "816-581-5899",
            "fax_number": "816-347-3046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RENFRO",
        "first_name": "RACHELLE",
        "middle_name": "ENDRIGAN",
        "name_prefix": "Mrs.",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-06-08",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Licensed Practical Nurse",
            "state": "MO",
            "license": "2010028206",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1841235298",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RACHELLE",
            "last_name": "STICKEN",
            "middle_name": "ENDRIGAN",
            "prefix": "MRS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Licensed Practical Nurse in Lees Summit, MO
• Providers in Lees Summit, MO by specialty
• Licensed Practical Nurse in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.