1558806000 NPI number — MRS. JOCELYN WARREN RD, LD, CNSC

Table of content: MRS. JOCELYN WARREN RD, LD, CNSC (NPI 1558806000)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558806000 NPI number — MRS. JOCELYN WARREN RD, LD, CNSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WARREN
Provider First Name:
JOCELYN
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD, LD, CNSC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WOMBLES
Provider Other First Name:
JOCELYN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RD, CD, CNSC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1558806000
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12495 HIGHWAY T
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARIONVILLE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65705-7121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-880-4187
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12495 HIGHWAY T
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARIONVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65705-7121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-880-4187
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/19/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  60694929 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133V00000X , with the licence number: 2018010193 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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