NPIMap

Organization Active NPI

Charis Healthcare of Missouri LLC

  • Nurse Practitioner
  • Kennett, MO
National Provider Identifier
1265394431
Registry record updated Nov 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
CHARIS HEALTHCARE OF MISSOURI LLC
Practice address
1815 Katelyn St
Kennett, MO 63857-4112
Phone
(870) 489-8633
NPI assigned
Nov 26, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2025

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

Authorized official

Name
Tiffany Moore, NP
Title
Owner
Phone
(870) 489-8633

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

1815 Katelyn St
Kennett, MO 63857-4112

Mailing address

1815 Katelyn St
Kennett, MO 63857-4112
Phone (870) 489-8633

National Provider Directory

National Provider Directory
Tax ID family
Charis Healthcare of Missouri LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1764115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764115200000",
    "number": "1265394431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1815 KATELYN ST",
            "city": "KENNETT",
            "state": "MO",
            "postal_code": "638574112",
            "telephone_number": "870-489-8633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1815 KATELYN ST",
            "city": "KENNETT",
            "state": "MO",
            "postal_code": "638574112",
            "telephone_number": "870-489-8633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARIS HEALTHCARE OF MISSOURI LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-11-26",
        "last_updated": "2025-11-26",
        "certification_date": "2025-11-26",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "870-489-8633",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kennett, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2025; 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.