Healthcare Provider Details

I. General information

NPI: 1508637091
Provider Name (Legal Business Name): JOSHUA DAVID WHITTINGTON APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2024
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E PRIMROSE ST STE 170
SPRINGFIELD MO
65807-5192
US

IV. Provider business mailing address

PO BOX 505673
SAINT LOUIS MO
63150-5673
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-6000
  • Fax: 417-269-9853
Mailing address:
  • Phone: 417-730-6430
  • Fax: 417-269-7567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2023045174
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: