Provider Demographics
NPI:1528366515
Name:COLLINSWORTH, KERI JO (RN, MSN, CPNP)
Entity Type:Individual
Prefix:MRS
First Name:KERI
Middle Name:JO
Last Name:COLLINSWORTH
Suffix:
Gender:F
Credentials:RN, MSN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:336 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:NEOSHO
Mailing Address - State:MO
Mailing Address - Zip Code:64850-1769
Mailing Address - Country:US
Mailing Address - Phone:417-451-0778
Mailing Address - Fax:417-451-0799
Practice Address - Street 1:336 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:NEOSHO
Practice Address - State:MO
Practice Address - Zip Code:64850-1769
Practice Address - Country:US
Practice Address - Phone:417-451-0778
Practice Address - Fax:417-451-0799
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO151489363LP0200X
MO2011004388363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics