Caleb Eggleston
Individual provider Active NPI Counselor · Republic, MO
NPI 1295572360 · NPPES record last updated Jul 15, 2024
Key facts
- NPI
- 1295572360
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- License
- 2024018840 (MO)
- Practice address
- 283 US Highway 60 W
Republic, MO 65738-1432 - Phone
- (417) 216-6189
- NPI assigned
- Jul 15, 2024
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2024018840 | MO | MD | Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor |
101Y00000X | 2024018840 | MO | Yes |
Addresses
Primary practice location
283 US Highway 60 W
Republic, MO 65738-1432
Mailing address
2005 S 22ND Ave
Ozark, MO 65721-8731
Phone (417) 689-3183
Other practice location 1
865 N Nicholas Rd
Nixa, MO 65714-7678
Phone (417) 689-3183
Other providers in Republic, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 15, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.