Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 2008012508 | MO |
NPI | 1073733069 |
---|---|
Provider Name | Kelly Jo Meier |
First Address | Joplin, MO 64804-3131 |
Second Address | Joplin, MO 64804-3131 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 05/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1073733069 | (05) | MO |