Healthcare Provider Details

I. General information

NPI: 1922590439
Provider Name (Legal Business Name): RYAN CHRISTOPHER JUNKIN NNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2018
Last Update Date: 11/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 E CHEROKEE ST
SPRINGFIELD MO
65804-2203
US

IV. Provider business mailing address

834 E ABBEY CT
NIXA MO
65714-7746
US

V. Phone/Fax

Practice location:
  • Phone: 417-820-2000
  • Fax:
Mailing address:
  • Phone: 205-534-0626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number2015026710
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number2018039919
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: