Provider Demographics
NPI:1811460975
Name:AURA, JOAN I (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:I
Last Name:AURA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2129 NASHVILLE ST
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-1347
Mailing Address - Country:US
Mailing Address - Phone:417-622-6450
Mailing Address - Fax:
Practice Address - Street 1:502 E GENERAL STEWART WAY STE A
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-2643
Practice Address - Country:US
Practice Address - Phone:912-368-1959
Practice Address - Fax:912-368-1966
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-10
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019000937363LF0000X
GAGAA-NP000111363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2019000937OtherCERTIFIED NURSE PRACTITIONER