Healthcare Provider Details

I. General information

NPI: 1982943502
Provider Name (Legal Business Name): JOSEPH M MEYSTRIK FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2013
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304A E 4TH ST
ELDON MO
65026-1808
US

IV. Provider business mailing address

306 BUSCH RD
JEFFERSON CITY MO
65101-8479
US

V. Phone/Fax

Practice location:
  • Phone: 573-392-5654
  • Fax:
Mailing address:
  • Phone: 417-818-5184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2013003461
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: