Provider Demographics
NPI:1235320607
Name:SKINNER, JAMES WILLIAM (MSN, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WILLIAM
Last Name:SKINNER
Suffix:
Gender:M
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 S PIN OAK DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65809-3143
Mailing Address - Country:US
Mailing Address - Phone:417-343-5692
Mailing Address - Fax:417-633-7030
Practice Address - Street 1:2130 S PIN OAK DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65809-3143
Practice Address - Country:US
Practice Address - Phone:417-343-5692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019033533363LP0808X
IA095382101YM0800X
MO101YP2500X
IAG157335363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional