Provider Demographics
NPI:1619497740
Name:STOGSDILL, ALICIA SUZANNE (MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:SUZANNE
Last Name:STOGSDILL
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E BATTLEFIELD ST STE 124
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5208
Mailing Address - Country:US
Mailing Address - Phone:417-986-1289
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:900 E BATTLEFIELD ST STE 124
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5208
Practice Address - Country:US
Practice Address - Phone:417-986-1289
Practice Address - Fax:417-269-7567
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOP16054146L00000X
MO2014002396163WE0003X
MO2017020145363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No163WE0003XNursing Service ProvidersRegistered NurseEmergency