Provider Demographics
NPI:1235165721
Name:DEVOE, MARY ANN (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:DEVOE
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:64803-3810
Mailing Address - Country:US
Mailing Address - Phone:417-347-8688
Mailing Address - Fax:417-347-8693
Practice Address - Street 1:3202 MCINTOSH CIR
Practice Address - Street 2:STE 102
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3646
Practice Address - Country:US
Practice Address - Phone:417-347-8688
Practice Address - Fax:417-347-8693
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO129116363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
500019747OtherRR MEDICARE
MO118126OtherANTHEM
OK100023320AMedicaid
KS100335980AMedicaid
MO423962208Medicaid
MO118126OtherANTHEM
S79306Medicare UPIN