Healthcare Provider Details

I. General information

NPI: 1780772004
Provider Name (Legal Business Name): NANCY J. PRICE APMHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY J WALSER

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 E 34TH ST
JOPLIN MO
64804-3924
US

IV. Provider business mailing address

PO BOX 2526
JOPLIN MO
64803-2526
US

V. Phone/Fax

Practice location:
  • Phone: 417-347-7550
  • Fax: 417-347-7560
Mailing address:
  • Phone: 417-347-7600
  • Fax: 417-347-7608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number070733
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: