Healthcare Provider Details

I. General information

NPI: 1568642452
Provider Name (Legal Business Name): OTOLARYNGOLOGY OF JOPLIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 E. 32ND ST.
JOPLIN MO
64804
US

IV. Provider business mailing address

1920 E. 32ND ST.
JOPLIN MO
64804
US

V. Phone/Fax

Practice location:
  • Phone: 417-781-4613
  • Fax: 417-781-0805
Mailing address:
  • Phone: 417-781-4613
  • Fax: 417-781-0805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number104366
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. RENEE A WALKER
Title or Position: OTOLARYNGOLOGIST
Credential: D.O.
Phone: 417-781-4613