Healthcare Provider Details

I. General information

NPI: 1285752865
Provider Name (Legal Business Name): JOY NNEKA EKE PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5604 NE ANTIOCH RD
GLADSTONE MO
64119-2327
US

IV. Provider business mailing address

1513 UNION AVE STE 2500
MOBERLY MO
65270-9412
US

V. Phone/Fax

Practice location:
  • Phone: 660-372-1313
  • Fax: 660-372-1339
Mailing address:
  • Phone: 660-372-1313
  • Fax: 660-372-1339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number53-45794-092
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2021029690
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: