Provider Demographics
NPI:1134976376
Name:JOINER, BOSYONPLETOOTH A
Entity type:Individual
Prefix:
First Name:BOSYONPLETOOTH
Middle Name:A
Last Name:JOINER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9703 MOHAWK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-2767
Mailing Address - Country:US
Mailing Address - Phone:318-560-4544
Mailing Address - Fax:
Practice Address - Street 1:9703 MOHAWK RIDGE DR
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-2767
Practice Address - Country:US
Practice Address - Phone:318-560-4544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000000000261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care