Provider Demographics
NPI:1710497136
Name:JOINER, JUSTIN LEE (FNP-C)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:LEE
Last Name:JOINER
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 SERENITY LN
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-7783
Mailing Address - Country:US
Mailing Address - Phone:417-536-1888
Mailing Address - Fax:
Practice Address - Street 1:2132 S STEWART AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804
Practice Address - Country:US
Practice Address - Phone:417-368-3489
Practice Address - Fax:417-268-9397
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011021523363LF0000X
MO2017036478364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist