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General NPI Number Information
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NPI Number | 1811646839
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Entity Type | Organization
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Legal Business Name | NEXTGEN DIAGNOSTIC SERVICES LLC
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Dates
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Enumeration Date | 03/18/2022
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Last Update Date | 03/18/2022
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Provider Practice Location Address
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Address Line | 407 S PENNSYLVANIA AVE STE 202
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City | JOPLIN
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State | MO
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Zip | 64801-2281
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Country | US
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Telephone | 417-362-6398
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Fax |
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Provider Business Mailing Address
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Address Line | 407 S PENNSYLVANIA AVE STE 202
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City | JOPLIN
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State | MO
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Zip | 64801-2281
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Country | US
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Telephone | 417-362-6398
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Fax |
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Authorized Official
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Title or Position | LAB DIRECTOR/OWNER
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Name | MS. NANDA ABIGAIL NUNNELLY-SPARKS
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Credential |
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Telephone | 417-499-1525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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