Individual provider Active NPI

Keandra Speakman, APRN, FNP

  • Family Nurse Practitioner
  • Cape Girardeau, MO
National Provider Identifier
1508561614
Registry record updated Sep 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2023007546 Issued in MO
Practice address
1723 Broadway St
Cape Girardeau, MO 63701-4566
Phone
(573) 331-7840
NPI assigned
Mar 31, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 12, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2023007546 MO Primary

Addresses

Primary practice location

1723 Broadway St
Cape Girardeau, MO 63701-4566

Mailing address

1723 Broadway St Ste 205
Cape Girardeau, MO 63701-4556
Phone (573) 331-7840

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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 1

Enrollment IDStateProvider typePAC IDDetails
I20230607001822 MO Practitioner - Nurse Practitioner 6103283130 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Health Facilities Rehab Services IncGroup PAC ID 3476679226, 152 clinicians
Southeast Missouri Hospital Physicians LLCGroup PAC ID 9133024334, 206 clinicians

Practice addresses (Care Compare)

1102 Sikes Ave
Sikeston, MO 63801-5021

1723 Broadway St
Suite 205
Cape Girardeau, MO 63701-4556
Phone (573) 331-7870

Hospital & facility affiliations

  • Mercy Hospital Southeast Hospital, Cape Girardeau, MO, CCN 260110
  • Mercy Hospital Stoddard Hospital, Dexter, MO, CCN 260160

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing

State licenses

LicenseStateTypeSpecialty
2023007546MOMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast Missouri Hospital Physicians, LLC CurrentSince Jun 5, 2023 Accepting new patients

Locations

1723 Broadway St
Cape Girardeau, MO 63701
Phone (573) 334-7861

1723 Broadway St
Ste 205
Cape Girardeau, MO 63701
Phone (573) 331-7830

1701 Lacey St
Cpe Girardeau, MO 63701
Phone (573) 334-4822

Organizations & group practices 2

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

Hospital & facility affiliations 2

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": "1680220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694476800000",
    "number": "1508561614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1723 BROADWAY ST STE 205",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637014556",
            "telephone_number": "573-331-7840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1723 BROADWAY ST",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637014566",
            "telephone_number": "573-331-7840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPEAKMAN",
        "first_name": "KEANDRA",
        "credential": "APRN, FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-03-31",
        "last_updated": "2023-09-12",
        "certification_date": "2023-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2023007546",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cape Girardeau, MO

Sources for this page

Verify at the official NPI Registry.