Individual provider Active NPI

Kristeena Ruth Whaley

  • Speech-Language Pathologist
  • Springfield, MO
National Provider Identifier
1689723835
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
0147680TC Issued in MO
Practice address
940 N Jefferson Ave
Springfield, MO 65802-3718
Phone
(417) 523-0000
NPI assigned
Jan 9, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 0147680TC MO Primary

Addresses

Primary practice location

940 N Jefferson Ave
Springfield, MO 65802-3718

Mailing address

3911 N Pickwick Ave
Springfield, MO 65803-5933
Phone (417) 523-1352

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

State licenses

LicenseStateTypeSpecialty
0147680TCMOMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1689723835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3911 N PICKWICK AVE",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658035933",
            "telephone_number": "417-523-1352",
            "fax_number": "417-523-1395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "940 N JEFFERSON AVE",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658023718",
            "telephone_number": "417-523-0000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHALEY",
        "first_name": "KRISTEENA",
        "middle_name": "RUTH",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MO",
            "license": "0147680TC",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.