Vitality Clinic

Primary specialty

Health EducatorTaxonomy code 174H00000X

Legal business name

VITALITY CLINIC

Practice address

111 N. Missouri Street
Jackson, MO 63755

Phone

(573) 755-0340

NPI assigned

Apr 22, 2015

Last updated

Apr 22, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jamie Kyle McCoy

Title

Owner

Phone

(573) 755-0340

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1429660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429660800000",
    "number": "1346637865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "465 S. MOUNT AUBURN RD",
            "address_2": "SUITE 103",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "63703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 N. MISSOURI STREET",
            "city": "JACKSON",
            "state": "MO",
            "postal_code": "63755",
            "telephone_number": "573-755-0340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITALITY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-22",
        "last_updated": "2015-04-22",
        "status": "A",
        "authorized_official_last_name": "MCCOY",
        "authorized_official_first_name": "JAMIE",
        "authorized_official_middle_name": "KYLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "573-755-0340"
    },
    "taxonomies": [
        {
            "code": "174H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Health Educator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trendline Consulting LLC
• Tricorex Inc. (Healthcare Equipment & Supply)
• Troy L Bell OD & Associates, PC (Troy Bell Family Eyecare)
• Troy L. Bell O.D. & Assoc PC
• Andria Dennis Turner, RN
• Wal-Mart Stores East LP (Walmart Pharmacy 10-0122)
• Wal-Mart Stores East, LP (Vision Center 30-0122)
• Courtney Drew Walker, COTA
• Amber Walter
• Judith Walton, MSP, CCC-SLP

• Health Educator in Jackson, MO
• Providers in Jackson, MO by specialty
• Health Educator in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.