Provider Demographics
NPI:1861735300
Name:CROUSE, EMILY KAY (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:KAY
Last Name:CROUSE
Suffix:
Gender:F
Credentials: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:PO BOX 4024
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65808-4024
Mailing Address - Country:US
Mailing Address - Phone:417-885-3888
Mailing Address - Fax:417-520-5959
Practice Address - Street 1:3801 S NATIONAL AVE STE 900
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5210
Practice Address - Country:US
Practice Address - Phone:417-885-3888
Practice Address - Fax:417-520-5959
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004018102163W00000X
MO2013004691363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP01208063OtherRR MCR
MO431560263OtherTRICARE
MO1861735300Medicaid
AR198607758Medicaid
MO431560263OtherTRICARE
AR198607758Medicaid