Individual provider Active NPI

Alivia Grace Acklin, AG-ACNP

  • Acute Care Nurse Practitioner
  • West Plains, MO
National Provider Identifier
1174404453
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
2025039655 Issued in MO
Practice address
1100 N Kentucky Ave
West Plains, MO 65775-2029
Phone
(417) 256-9111
NPI assigned
Sep 11, 2025
Last updated
Sep 11, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 2025039655 MO Primary

Addresses

Primary practice location

1100 N Kentucky Ave
West Plains, MO 65775-2029

Mailing address

303 Westmont Ave
West Plains, MO 65775-2573
Phone (660) 973-8377

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20251211003759 MO Practitioner - Nurse Practitioner 0446744874 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ies HSP Missouri LLCGroup PAC ID 3173989290, 25 clinicians

Practice addresses (Care Compare)

1100 N Kentucky Ave
West Plains, MO 65775-2029
Phone (417) 257-6789

3100 Oak Grove Rd
Poplar Bluff, MO 63901-1573
Phone (573) 785-7721

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2025039655MOMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ies HSP Missouri LLC CurrentSince Nov 10, 2025 Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

3100 Oak Grove Rd
Rombauer, MO 63901
Phone (573) 776-2000

1100 N Kentucky Ave
West Plains, MO 65775
Phone (417) 257-5959

Organizations & group practices 2

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

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1757548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1174404453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 WESTMONT AVE",
            "city": "WEST PLAINS",
            "state": "MO",
            "postal_code": "657752573",
            "telephone_number": "660-973-8377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 N KENTUCKY AVE",
            "city": "WEST PLAINS",
            "state": "MO",
            "postal_code": "657752029",
            "telephone_number": "417-256-9111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ACKLIN",
        "first_name": "ALIVIA",
        "middle_name": "GRACE",
        "name_prefix": "Mrs.",
        "credential": "AG-ACNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-09-11",
        "last_updated": "2025-09-11",
        "certification_date": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MO",
            "license": "2025039655",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Plains, MO

Sources for this page

Verify at the official NPI Registry.