Healthcare Provider Details

I. General information

NPI: 1992648141
Provider Name (Legal Business Name): CIANNA NOEMI PATRICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500B E 32ND ST
JOPLIN MO
64804-4404
US

IV. Provider business mailing address

1000 SWN DR STE 101
CONWAY AR
72032-2558
US

V. Phone/Fax

Practice location:
  • Phone: 417-530-5654
  • Fax:
Mailing address:
  • Phone: 501-328-3274
  • Fax: 501-328-3274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: