Provider Demographics
NPI:1144257130
Name:CLEMENT, JOYCE (NP)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3810
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803
Mailing Address - Country:US
Mailing Address - Phone:417-347-7009
Mailing Address - Fax:417-347-3288
Practice Address - Street 1:1532 W 32ND ST
Practice Address - Street 2:STE 401
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1607
Practice Address - Country:US
Practice Address - Phone:417-347-7009
Practice Address - Fax:417-347-3288
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO054405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100258140AMedicaid
500010967OtherRR MEDICARE
MO130573OtherANTHEM
MO428606339Medicaid
KS100280570BMedicaid
MO130573OtherANTHEM
KS100280570BMedicaid