Provider Demographics
NPI:1073733069
Name:MEIER, KELLY JO (DO)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:JO
Last Name:MEIER
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:2719 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-3131
Mailing Address - Country:US
Mailing Address - Phone:417-782-5522
Mailing Address - Fax:417-782-5866
Practice Address - Street 1:2719 E 32ND ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3131
Practice Address - Country:US
Practice Address - Phone:417-782-5522
Practice Address - Fax:417-782-5866
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20080125082080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1073733069Medicaid