Healthcare Provider Details

I. General information

NPI: 1053800565
Provider Name (Legal Business Name): JOYCE D OGLESBY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2018
Last Update Date: 12/14/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S 11TH ST
WILLIAMS AZ
86046-2822
US

IV. Provider business mailing address

2323 E GREENLAW LN STE 10B
FLAGSTAFF AZ
86004-1849
US

V. Phone/Fax

Practice location:
  • Phone: 928-699-1840
  • Fax:
Mailing address:
  • Phone: 928-226-1097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number8492674
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: