Healthcare Provider Details

I. General information

NPI: 1205024668
Provider Name (Legal Business Name): KARA C. JOYNER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARA C. KOLDEN

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 E STATE ST
ROCKFORD IL
61104-2315
US

IV. Provider business mailing address

PO BOX 78866
MILWAUKEE WI
53278-8866
US

V. Phone/Fax

Practice location:
  • Phone: 779-696-4400
  • Fax:
Mailing address:
  • Phone: 779-696-7150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number085003130
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085-003130
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: