Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 115577 | MO |
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 3926 | OK |
N | 207Q00000X | Family Doctor | 115577 | MO |
N | 207Q00000X | Family Doctor | 3926 | OK |
NPI | 1225057581 |
---|---|
Provider Name | Kelley Jean Joy |
First Address | Joplin, MO 64804-5229 |
Second Address | Pryor, OK 74361-4203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 30/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
030474832 | TAX ID # (01) | OK |
100195450B | (05) | OK |
H67447 | (02) | OK |