Active NPI
Catherine M Hissink, MS
- Psychologist
- Nevada, MO
National Provider Identifier
1295892750
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 01351
- Practice address
- 300 W Cherry St
Nevada, MO 64772-2202 - Phone
- (417) 667-4230
- Fax
- (417) 667-7607
- NPI assigned
- Jan 3, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 01351 | MO | Primary |
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility | 320900000X | PY01351 | MO |
Addresses
Primary practice location
300 W Cherry St
Nevada, MO 64772-2202
Mailing address
300 W Cherry St
P. O. Box 125
Nevada, MO 64772-2202
Phone (417) 667-4230
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 493314306 | Medicaid | MO | |
| 20591015 | Other | MO | BLUE CROSS OF WESTERN MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01351 | MO | MD | Psychologist |
| PY01351 | MO | MD | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167782400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1369785600000",
"number": "1295892750",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 W CHERRY ST",
"address_2": "P. O. BOX 125",
"city": "NEVADA",
"state": "MO",
"postal_code": "647722202",
"telephone_number": "417-667-4230",
"fax_number": "417-667-7607"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 W CHERRY ST",
"city": "NEVADA",
"state": "MO",
"postal_code": "647722202",
"telephone_number": "417-667-4230",
"fax_number": "417-667-7607"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HISSINK",
"first_name": "CATHERINE",
"middle_name": "M",
"credential": "MS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-03",
"last_updated": "2013-05-29",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MO",
"license": "01351",
"primary": true
},
{
"code": "320900000X",
"taxonomy_group": "",
"desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
"state": "MO",
"license": "PY01351",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "493314306",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS OF WESTERN MO",
"identifier": "20591015",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Nevada, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.