Provider Demographics
NPI:1336461268
Name:HOMESLEY, MICHELLE L (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:L
Last Name:HOMESLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 S NATIONAL AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2213
Mailing Address - Country:US
Mailing Address - Phone:417-886-5000
Mailing Address - Fax:417-886-1100
Practice Address - Street 1:1911 S NATIONAL AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2213
Practice Address - Country:US
Practice Address - Phone:417-886-5000
Practice Address - Fax:417-886-1100
Is Sole Proprietor?:No
Enumeration Date:2010-02-19
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010005645363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1336461268Medicaid
1336461268Medicare UPIN
MO1336461268Medicaid
1336461268Medicare Oscar/Certification
1336461268Medicare PIN