Healthcare Provider Details

I. General information

NPI: 1255116471
Provider Name (Legal Business Name): JOSHUA W HAMER LPN, CPHT, CHW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 08/28/2023
Certification Date: 08/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 W KEARNEY ST STE 116
SPRINGFIELD MO
65803-2055
US

IV. Provider business mailing address

2650 W KEARNEY ST STE 116
SPRINGFIELD MO
65803-2055
US

V. Phone/Fax

Practice location:
  • Phone: 417-865-1547
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number2020033222
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number2023034713
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: