Healthcare Provider Details

I. General information

NPI: 1780666214
Provider Name (Legal Business Name): JOSEPH D FOLLIS APRN,BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 N POMME DE TERRE AVE
BOLIVAR MO
65613-1241
US

IV. Provider business mailing address

714 N POMME DE TERRE AVE
BOLIVAR MO
65613-1241
US

V. Phone/Fax

Practice location:
  • Phone: 417-326-4000
  • Fax: 417-326-6400
Mailing address:
  • Phone: 417-326-4000
  • Fax: 417-326-6400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number126205
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: