Provider Demographics
NPI:1982943502
Name:MEYSTRIK, JOSEPH M (FNP)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:MEYSTRIK
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 BUSCH RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65101-8479
Mailing Address - Country:US
Mailing Address - Phone:417-818-5184
Mailing Address - Fax:
Practice Address - Street 1:608 OLD ROUTE 66
Practice Address - Street 2:
Practice Address - City:SAINT ROBERT
Practice Address - State:MO
Practice Address - Zip Code:65584-3730
Practice Address - Country:US
Practice Address - Phone:573-336-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-01
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013003461363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1982943502Medicaid
MO420002737Medicaid
MOP01173069OtherRR MCR
MO431560263OtherTRICARE
MO1982943502Medicaid