Healthcare Provider Details

I. General information

NPI: 1386227304
Provider Name (Legal Business Name): JONATHAN KYU CHANG DNP, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4430 MISSOURI AVE
FORT LEONARD WOOD MO
65473-9098
US

IV. Provider business mailing address

4234 ILLINOIS AVE
FORT LEONARD WOOD MO
65473-9098
US

V. Phone/Fax

Practice location:
  • Phone: 573-596-5942
  • Fax:
Mailing address:
  • Phone: 573-596-0035
  • Fax: 877-874-1019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number989250
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: