Provider Demographics
NPI:1386836989
Name:KLINGENSMITH, RICK (FNP)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:
Last Name:KLINGENSMITH
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 S NATIONAL AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5287
Mailing Address - Country:US
Mailing Address - Phone:417-882-4880
Mailing Address - Fax:417-882-7843
Practice Address - Street 1:3850 S NATIONAL AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5287
Practice Address - Country:US
Practice Address - Phone:417-882-4880
Practice Address - Fax:417-882-7843
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOF0307020363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO427016407Medicaid
MOP00480403OtherRAILROAD MEDICARE
MO431188342OtherUNITED HEALTHCARE
MO835720607Medicare PIN