Healthcare Provider Details

I. General information

NPI: 1194267161
Provider Name (Legal Business Name): JOSHUA CLAY HERBERT NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 W FOXWOOD DR
RAYMORE MO
64083-8301
US

IV. Provider business mailing address

1215 W FOXWOOD DR
RAYMORE MO
64083-8301
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 866-389-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2016039173
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-82533-102
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: