Provider Demographics
NPI:1073268082
Name:ESSELMAN, MICHELLE C (CPNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:C
Last Name:ESSELMAN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:HEASLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2716 W REPUBLIC RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-3901
Mailing Address - Country:US
Mailing Address - Phone:417-520-5130
Mailing Address - Fax:
Practice Address - Street 1:2716 W REPUBLIC RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-3901
Practice Address - Country:US
Practice Address - Phone:417-520-5130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022005934363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics