Provider Demographics
NPI:1023369774
Name:RAPIER, ELYSSA N (CPNP)
Entity Type:Individual
Prefix:
First Name:ELYSSA
Middle Name:N
Last Name:RAPIER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 S VENTURA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2700
Mailing Address - Country:US
Mailing Address - Phone:417-233-1100
Mailing Address - Fax:417-622-4454
Practice Address - Street 1:1901 S VENTURA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2700
Practice Address - Country:US
Practice Address - Phone:417-233-1100
Practice Address - Fax:417-622-4454
Is Sole Proprietor?:No
Enumeration Date:2012-09-20
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012034195363LP0200X
MO2008020303363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPENDINGMedicaid
MOPENDINGOtherRR MCR
MOPENDINGMedicaid
MOPENDINGMedicaid