Organization Active NPI

AIDS Project of the Ozarks

  • Nurse Practitioner
  • Springfield, MO
National Provider Identifier
1366634859
Registry record updated Feb 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
AIDS PROJECT OF THE OZARKS
Practice address
1636 So. Glenstone, Ste. 100
Springfield, MO 65804-6580
Phone
(417) 881-1300
Fax
(417) 881-1237
NPI assigned
Aug 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2026

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

Authorized official

Name
Amber Cornelison
Title
Office Manager
Phone
(417) 881-1900

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

1636 So. Glenstone, Ste. 100
Springfield, MO 65804-6580

Mailing address

1636 So. Glenstone, Ste. 100
Springfield, MO 65804-1434
Phone (417) 881-1300

Other identifiers 1

IdentifierTypeStateIssuer
600045091MedicaidMO

Other names 1

  • APO Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080922000178 MO Part B Supplier - Clinic/Group Practice 4981771730 Receives reassigned benefits from 9 practitioners
Practice locations: Springfield, MO
O20230228001401 MO Part A Provider - Federally Qualified Health Center (FQHC) 4981771730 Practice locations: Springfield, MO

Federally qualified health center certification: CCN 261923

Legal name
AIDS PROJECT OF THE OZARKS
Doing business as
APO
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 27, 2023
Last certification
Feb 27, 2023
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Oct 30, 1985 in MO
Enrollment address
1636 S Glenstone Ave
Ste 100
Springfield, MO 65804-1527

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory

Locations

303 Park Central W
Springfield, MO 65806
Phone (417) 881-1900

Ownership & related parties

All disclosed owners & managing parties 15

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Teressa Crane-Brown Individual Corporate Officer Aug 1, 2008
Corporate Director Aug 1, 2008
Chris Rees Individual Corporate Officer Aug 1, 2008
Corporate Director Aug 1, 2008
Jonathan Johnson Individual Corporate Officer Aug 1, 2008
Corporate Director Aug 1, 2008
Jeffery Tumlin Individual Corporate Officer Aug 1, 2008
Corporate Director Aug 1, 2008
Joy Fountain Individual Corporate Officer Aug 1, 2008
Corporate Director Aug 1, 2008
Tom Vandeberg Individual Corporate Officer Aug 1, 2008
Corporate Director Aug 1, 2008
Bradley M Haller Individual Corporate Officer Feb 1, 2014
Corporate Director Feb 1, 2014
Michelle Winslow Individual Corporate Officer Aug 1, 2008
Corporate Director Aug 1, 2008
Shelly J Farnan-Moore Individual Corporate Officer Aug 1, 2008
Corporate Director Aug 1, 2008
Lynne Meyerkord Individual Corporate Officer Jan 1, 2014
Corporate Director Jan 1, 2014
W-2 Managing Employee Aug 1, 2008
Clarissa French Individual Corporate Officer Aug 1, 2008
Corporate Director Aug 1, 2008
Jane Pike Individual Corporate Officer Aug 1, 2008
Corporate Director Aug 1, 2008
Rose Degray Individual Corporate Officer Sep 18, 2013
Corporate Director Sep 18, 2013
Kris Barefield Individual Corporate Officer Aug 1, 2008
Corporate Director Aug 1, 2008
Emily Bowen Individual Corporate Officer Aug 1, 2008
Corporate Director Aug 1, 2008

Practitioners & affiliated clinicians

Practitioners 9

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": "1187308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770249600000",
    "number": "1366634859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1636 SO. GLENSTONE, STE. 100",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658041434",
            "telephone_number": "417-881-1300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1636 SO. GLENSTONE, STE. 100",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658046580",
            "telephone_number": "417-881-1300",
            "fax_number": "417-881-1237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AIDS PROJECT OF THE OZARKS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-17",
        "last_updated": "2026-02-05",
        "certification_date": "2026-02-05",
        "status": "A",
        "authorized_official_last_name": "CORNELISON",
        "authorized_official_first_name": "AMBER",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "417-881-1900"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "600045091",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "APO",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "APO",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Springfield, MO

Sources for this page

Verify at the official NPI Registry.