Alicia Pry, CPHT, CHW-C

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

License

17294 Issued in MO

Practice address

2650 W Kearney St Ste 116
Springfield, MO 65803-2055

Phone

(417) 865-1547

Fax

(417) 862-2571

NPI assigned

Aug 22, 2024

Last updated

Aug 22, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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": "1724284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724284800000",
    "number": "1265265581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1457 E LINDBERG ST",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658042418",
            "telephone_number": "417-773-8997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 W KEARNEY ST STE 116",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658032055",
            "telephone_number": "417-865-1547",
            "fax_number": "417-862-2571"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRY",
        "first_name": "ALICIA",
        "credential": "CPHT, CHW-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-22",
        "last_updated": "2024-08-22",
        "certification_date": "2024-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183700000X",
            "taxonomy_group": "",
            "desc": "Pharmacy Technician",
            "state": "MO",
            "license": "2018012435",
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "MO",
            "license": "17294",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jaimyn Prost, PHARMD, BCPS
• Christian A Provence-Harmon, MSW, LCSW
• Stephanie Annette Pruett, RN
• Timothy O Pruett, FNP
• Lisa Pruitt, MS, PLPC
• Psych Associates LLC
• Psych Revival Therapy LLC
• Psychology Services, PC
• Bailey A Puckett, MS, LPC
• Samantha Puhl, PA

• Community Health Worker in Springfield, MO
• Providers in Springfield, MO by specialty
• Community Health Worker in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2024; 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.