Individual provider Active NPI

Kimberly B. McCandless, ANP

  • Adult Health Nurse Practitioner
  • Springfield, MO
National Provider Identifier
1417289992
Registry record updated Feb 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
2005008103 Issued in MO
Practice address
2115 S Fremont Ave
Suite 4300
Springfield, MO 65804-2239
Phone
(417) 820-3911
Fax
(417) 820-3924
NPI assigned
Feb 8, 2010
Last updated
Feb 8, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 2005008103 MO Primary

Addresses

Primary practice location

2115 S Fremont Ave
Suite 4300
Springfield, MO 65804-2239

Mailing address

PO Box 2580
Springfield, MO 65801-2580
Phone (417) 829-4620

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, HI2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20100327000573 MO Practitioner - Nurse Practitioner 4183750268 Reassigns benefits to 2 organizations
I20210430001001 HI Practitioner - Nurse Practitioner 4183750268 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Renaissance Imaging Medical Associates IncGroup PAC ID 7315841756, 126 clinicians

Practice addresses (Care Compare)

149 Kawika PL
Honolulu, HI 96822-5006
Phone (818) 435-1433

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2005008103MOMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Springfield Communities CurrentSince Sep 29, 2025 Accepting new patients
Golden State Imaging Associates Inc CurrentSince Sep 7, 2023 Accepting new patients
Renaissance Imaging Medical Associates, Inc. CurrentSince Dec 1, 2020 Accepting new patients

Locations

18436 Roscoe Blvd
Northridge, CA 91325
Phone (805) 577-2012

1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379

1605 Martin Springs Dr
Ste 330
Rolla, MO 65401
Phone (573) 458-6379

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1265587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265587200000",
    "number": "1417289992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2580",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658012580",
            "telephone_number": "417-829-4620",
            "fax_number": "417-829-4316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2115 S FREMONT AVE",
            "address_2": "SUITE 4300",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658042239",
            "telephone_number": "417-820-3911",
            "fax_number": "417-820-3924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCANDLESS",
        "first_name": "KIMBERLY",
        "middle_name": "B.",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-02-08",
        "last_updated": "2010-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MO",
            "license": "2005008103",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MO

Sources for this page

Verify at the official NPI Registry.