NPIMap

Organization Active NPI

Visiting Nurse Association of Southeast Missouri Inc

  • Family Nurse Practitioner
  • Kennett, MO
National Provider Identifier
1295403202
Registry record updated Mar 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
VISITING NURSE ASSOCIATION OF SOUTHEAST MISSOURI INC
Practice address
1124 Independence Ave
Kennett, MO 63857-1314
Phone
(573) 888-5892
Fax
(573) 888-0538
NPI assigned
Sep 3, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2023

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

Authorized official

Name
Shonda Hollomon Young
Title
Ceo
Phone
(573) 888-5892

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X Primary

Addresses

Primary practice location

1124 Independence Ave
Kennett, MO 63857-1314

Mailing address

PO Box 768
Kennett, MO 63857-0768
Phone (800) 286-5892

Other practice location 1

919 West Business US Hwy 60
Dexter, MO 63841
Phone (800) 286-5892

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211011002819 MO Part B Supplier - Clinic/Group Practice 6406983139 Receives reassigned benefits from 7 practitioners
Practice locations: Kennett, MO

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Visiting Nurse Association of Southeast Missouri Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

2311 Bloomfield Rd
Ste 103
Cape Girardeau, MO 63703
Phone (800) 286-5892

919 W Business US Highway 60
Dexter, MO 63841
Phone (573) 888-5892

1112 South Byp
Ste E
Kennett, MO 63857
Phone (573) 888-0417

923 W Pine St
Poplar Bluff, MO 63901
Phone (573) 686-3480

607 S Main St
Sikeston, MO 63801
Phone (573) 471-0520

1218 Linn St
Sikeston, MO 63801
Phone (573) 888-5892

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1630627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677715200000",
    "number": "1295403202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 768",
            "city": "KENNETT",
            "state": "MO",
            "postal_code": "638570768",
            "telephone_number": "800-286-5892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1124 INDEPENDENCE AVE",
            "city": "KENNETT",
            "state": "MO",
            "postal_code": "638571314",
            "telephone_number": "573-888-5892",
            "fax_number": "573-888-0538"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "919 West Business US Hwy 60",
            "address_purpose": "LOCATION",
            "city": "Dexter",
            "state": "MO",
            "postal_code": "63841",
            "country_code": "US",
            "telephone_number": "800-286-5892",
            "fax_number": "573-888-0538",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "VISITING NURSE ASSOCIATION OF SOUTHEAST MISSOURI INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-03",
        "last_updated": "2023-03-02",
        "certification_date": "2023-02-28",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "SHONDA",
        "authorized_official_middle_name": "HOLLOMON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "573-888-5892"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "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 Mar 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.