NPIMap

Individual provider Active NPI

Renae Jenelle Richardson

  • Nurse Practitioner
  • Kimberling City, MO
National Provider Identifier
1659045847
Registry record updated Nov 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
2021019189 Issued in MO
Practice address
11863 State Highway 13
Kimberling City, MO 65686-8362
Phone
(417) 739-1995
NPI assigned
Aug 3, 2021
Last updated
Nov 20, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 2021019189 MO Primary

Addresses

Primary practice location

11863 State Highway 13
Kimberling City, MO 65686-8362

Mailing address

4332 E Ambrose Dr
Springfield, MO 65802-2425
Phone (417) 251-2922

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210907001174 MO Practitioner - Nurse Practitioner 4486050036 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Clinic Springfield CommunitiesGroup PAC ID 7416865845, shared by 26 NPIs, 1,121 clinicians

Practice addresses (Care Compare)

18598 Business
Suite 13
Branson West, MO 65737-9659
Phone (417) 272-8497

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Springfield Communities CurrentSince Nov 18, 2024 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Nov 18, 2024 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Nov 18, 2024 Accepting new patients
Ozarks Medical Center Past Accepting new patients
Lester E Cox Medical Centers PastSince Mar 13, 2022 Accepting new patients

Locations

18598 Business 13
Reeds Spring, MO 65737
Phone (417) 272-1785

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

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

2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905

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 12

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": "1627948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668902400000",
    "number": "1659045847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4332 E AMBROSE DR",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658022425",
            "telephone_number": "417-251-2922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11863 STATE HIGHWAY 13",
            "city": "KIMBERLING CITY",
            "state": "MO",
            "postal_code": "656868362",
            "telephone_number": "417-739-1995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "RENAE",
        "middle_name": "JENELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-03",
        "last_updated": "2022-11-20",
        "certification_date": "2022-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MO",
            "license": "2021019189",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kimberling City, MO

Sources for this page

Verify at the official NPI Registry.