Healthcare Provider Details

I. General information

NPI: 1548422736
Provider Name (Legal Business Name): JOYCE M. PATRIKUS NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2008
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 S NATIONAL AVE STE G800
SPRINGFIELD MO
65807-6117
US

IV. Provider business mailing address

PO BOX 802843
KANSAS CITY MO
64180-2843
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-6184
  • Fax: 417-269-4608
Mailing address:
  • Phone: 417-730-6430
  • Fax: 417-269-7567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number129548
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: