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General NPI Number Information
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NPI Number | 1861172397
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Entity Type | Individual
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Provider Name | JOHN PAUL HAMM AGPCNP-BC
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Gender | Male
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Dates
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Enumeration Date | 07/19/2023
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Last Update Date | 07/19/2023
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Provider Practice Location Address
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Address Line | 211 SAINT FRANCIS DR
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63703-5049
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Country | US
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Telephone | 573-331-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 490 STATE HIGHWAY A
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City | BENTON
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State | MO
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Zip | 63736-8156
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Country | US
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Telephone | 573-382-0289
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 2022017346
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License Number State | MO
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