Provider Demographics
NPI:1053165183
Name:JURGENSMEYER, SALLY (APRN WHNP-BC)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:JURGENSMEYER
Suffix:
Gender:F
Credentials:APRN WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 E WAYLAND ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-3167
Mailing Address - Country:US
Mailing Address - Phone:417-619-2369
Mailing Address - Fax:
Practice Address - Street 1:1500 W STATE HIGHWAY J
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-7425
Practice Address - Country:US
Practice Address - Phone:417-485-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024013578363LX0001X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology