Provider Demographics
NPI:1154733806
Name:MCCONNELL, VANESSA (FNP)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 S FREMONT AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2206
Mailing Address - Country:US
Mailing Address - Phone:417-820-3554
Mailing Address - Fax:417-820-3587
Practice Address - Street 1:2055 S FREMONT AVE
Practice Address - Street 2:STE 200
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2206
Practice Address - Country:US
Practice Address - Phone:417-820-3554
Practice Address - Fax:417-820-3587
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005027416363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily