Healthcare Provider Details

I. General information

NPI: 1831627041
Provider Name (Legal Business Name): LATONYA BILLUPS AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2017
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2218 W 32ND ST
JOPLIN MO
64804-3514
US

IV. Provider business mailing address

50 S B B KING BLVD STE 100
MEMPHIS TN
38103-2626
US

V. Phone/Fax

Practice location:
  • Phone: 205-343-7300
  • Fax: 205-722-5335
Mailing address:
  • Phone: 901-436-1381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2016001665
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAG1115069
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: