Jeannette G Provance

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

0334890 Issued in MO

Practice address

505 Burkhart
Malden, MO 63863

Phone

(573) 276-5791

Fax

(573) 276-4993

NPI assigned

Mar 27, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Malden R-I School District

  • Local Education Agency (LEA)
  • Malden, MO
  • NPI 1225153026
  NPD (past)

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

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619095544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 BURKHART",
            "city": "MALDEN",
            "state": "MO",
            "postal_code": "63863",
            "telephone_number": "573-276-5791",
            "fax_number": "573-276-4993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 BURKHART",
            "city": "MALDEN",
            "state": "MO",
            "postal_code": "63863",
            "telephone_number": "573-276-5791",
            "fax_number": "573-276-4993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVANCE",
        "first_name": "JEANNETTE",
        "middle_name": "G",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MO",
            "license": "0334890",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Taylor Phelps
• Poplar Bluff Regional Medical Center LLC (Malden Medical Center)
• Poplar Bluff Regional Medical Center, LLC (Malden Medical Center)
• Natalie Powell
• Premiere Healthcare LLC (Malden Pharmacy & Home Medical Equipment)
• Rehab Outreach, L.L.C. (SEMO Sports and Rehabilitation Center)
• Rita D. Knight-Ritchie Dba Friends in-Home Services
• Rita Knight-Ritchie Dba Friends in-Home Services
• Lakeshia Rochelle Robinson
• Sage Creek Home Care LLC

• Speech-Language Pathologist in Malden, MO
• Providers in Malden, MO by specialty
• Speech-Language Pathologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.