Provider Demographics
NPI:1962451559
Name:JUNEARICK, JOAN LASHALL
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:LASHALL
Last Name:JUNEARICK
Suffix:
Gender:F
Credentials:
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 912
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:MS
Mailing Address - Zip Code:38879-0912
Mailing Address - Country:US
Mailing Address - Phone:662-844-9763
Mailing Address - Fax:662-844-9763
Practice Address - Street 1:813 VARSITY DR
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4703
Practice Address - Country:US
Practice Address - Phone:662-844-9763
Practice Address - Fax:662-844-9763
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03537734Medicaid