Provider Demographics
NPI:1275530370
Name:MOHR, JOY S (PA-C)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:S
Last Name:MOHR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 TALL GRASS AVE
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:IA
Mailing Address - Zip Code:52340-4753
Mailing Address - Country:US
Mailing Address - Phone:319-545-2222
Mailing Address - Fax:319-545-2365
Practice Address - Street 1:1110 TALL GRASS AVE
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:IA
Practice Address - Zip Code:52340-4753
Practice Address - Country:US
Practice Address - Phone:319-545-2222
Practice Address - Fax:319-545-2365
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001323363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP14648Medicare UPIN