Provider Demographics
NPI:1548789209
Name:KO, JOANNA SCHREIT (RN BSN APRN FNP)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:SCHREIT
Last Name:KO
Suffix:
Gender:F
Credentials:RN BSN APRN FNP
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Mailing Address - Street 1:1000 W KINGSHIGHWAY STE 14
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-4197
Mailing Address - Country:US
Mailing Address - Phone:870-239-8591
Mailing Address - Fax:870-239-8137
Practice Address - Street 1:4000 LINWOOD DR STE G
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-7224
Practice Address - Country:US
Practice Address - Phone:870-239-8268
Practice Address - Fax:870-239-8277
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARA005208363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR225774758Medicaid