Provider Demographics
NPI:1578533758
Name:KESSINGER, AMY ELIZABETH (PSYD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ELIZABETH
Last Name:KESSINGER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2580
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-2580
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:417-829-4316
Practice Address - Street 1:SPRINGFIELD PUBLIC SCHOOLS
Practice Address - Street 2:1610 E. SUNSHINE ST.
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804
Practice Address - Country:US
Practice Address - Phone:417-820-9590
Practice Address - Fax:417-820-9592
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002004681103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR189458719Medicaid
MO431560263OtherTRICARE
MO1578533758Medicaid
MO159209OtherBLUE CROSS BLUE SHIELD
MOP00985995OtherRR MCR
MO000071252Medicare ID - Type Unspecified
MO1578533758Medicaid