Provider Demographics
NPI:1386649408
Name:ENDSLEY, CHAROLETTE ANN (MD)
Entity type:Individual
Prefix:
First Name:CHAROLETTE
Middle Name:ANN
Last Name:ENDSLEY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 MYRON WHITE
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65669
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1810 MYRON WHITE
Practice Address - Street 2:
Practice Address - City:HIGHLANDVILLE
Practice Address - State:MO
Practice Address - Zip Code:65669
Practice Address - Country:US
Practice Address - Phone:417-587-3262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007006879207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARG43491Medicare UPIN