Individual provider Active NPI

Angela Kearns

  • Clinical Social Worker
  • Potosi, MO
National Provider Identifier
1881089324
Registry record updated Feb 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
2012031864 Issued in MO
Practice address
1 Southtowne Dr
Potosi, MO 63664-5729
Phone
(573) 438-9355
NPI assigned
Apr 1, 2015
Last updated
Feb 23, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 2012031864 MO Primary

Addresses

Primary practice location

1 Southtowne Dr
Potosi, MO 63664-5729

Mailing address

1 Southtowne Dr
Potosi, MO 63664-5729
Phone (573) 438-9355

Other identifiers 1

IdentifierTypeStateIssuer
1952424566MedicaidMO

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171011001540 MO Practitioner - Clinical Social Worker 0547535924 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2012031864MOMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Great Mines Health Center CurrentSince Oct 5, 2017 Accepting new patients
Great Mines Health Center CurrentSince Oct 5, 2017 Accepting new patients
Valley Springs Youth Ranch Past Accepting new patients
Valley Springs Enterprises, Inc. PastSince Sep 25, 2022 Accepting new patients

Locations

1 Southtowne Dr
Potosi, MO 63664
Phone (573) 438-8401

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1427846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771804800000",
    "number": "1881089324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 SOUTHTOWNE DR",
            "city": "POTOSI",
            "state": "MO",
            "postal_code": "636645729",
            "telephone_number": "573-438-9355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 SOUTHTOWNE DR",
            "city": "POTOSI",
            "state": "MO",
            "postal_code": "636645729",
            "telephone_number": "573-438-9355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEARNS",
        "first_name": "ANGELA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-01",
        "last_updated": "2026-02-23",
        "certification_date": "2026-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2012031864",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1952424566",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Potosi, MO

Sources for this page

Verify at the official NPI Registry.