Healthcare Provider Details

I. General information

NPI: 1902343247
Provider Name (Legal Business Name): KATHERINE JOSEPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2017
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N MAIN ST
GIDEON MO
63848-9253
US

IV. Provider business mailing address

100 N MAIN ST
GIDEON MO
63848-9253
US

V. Phone/Fax

Practice location:
  • Phone: 573-448-3800
  • Fax:
Mailing address:
  • Phone: 573-448-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2023041661
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: