Josetta Eliese Wahwassuck, MSN, FNP, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

096721 Issued in MO

Practice address

206 S Mill St
Eldon, MO 65026-1864

Phone

(888) 403-1071

NPI assigned

Jan 27, 2006

Last updated

Jun 28, 2021By 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 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

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.

• Adult Quick Care, LLC

  • Emergency Medicine Physician
  • Independence, MO
  • NPI 1700057387
  NPD (past)
• Bates County Medical Clinic Inc

  • Rural Health Clinic/Center
  • Butler, MO
  • NPI 1013948868
  NPD (past)
• Carondelet Emergency Physicians Inc

  • Emergency Medicine Physician
  • Kansas City, MO
  • NPI 1558363838
  NPD (past)
• EMS, LLC

  • Emergency Medicine Physician
  • Kansas City, MO
  • NPI 1114154200
  NPD (past)
• Medical Emergency Associates L.L.C.

  • Emergency Medicine Physician
  • Blue Springs, MO
  • NPI 1346241593
  NPD (past)
• Occupational Medicine of Northwest Missouri, LLC

  • Occupational Medicine Clinic/Center
  • Saint Joseph, MO
  • NPI 1073767521
  NPD (past)

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

{
    "created_epoch": "1138320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624838400000",
    "number": "1629049929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 COMMUNITY",
            "city": "CLINTON",
            "state": "MO",
            "postal_code": "647358804",
            "telephone_number": "660-885-8131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 S MILL ST",
            "city": "ELDON",
            "state": "MO",
            "postal_code": "650261864",
            "telephone_number": "888-403-1071"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "227 Metro Dr",
            "address_purpose": "LOCATION",
            "city": "Jefferson City",
            "state": "MO",
            "postal_code": "651091134",
            "country_code": "US",
            "telephone_number": "888-403-1071",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAHWASSUCK",
        "first_name": "JOSETTA",
        "middle_name": "ELIESE",
        "credential": "MSN, FNP, PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-27",
        "last_updated": "2021-06-28",
        "certification_date": "2021-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "096721",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "KS",
            "license": "44870",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MO",
            "license": "096721",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "423989722",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "29929044",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00430963",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sunbrook Management (Lee House of Eldon, LLC)
• Marilyn J Sunde
• Laura M Thompson, NP-C
• Vernon Dental Clinic (King Dental Clinic)
• Caitlyn Vernon
• Wal-Mart Stores East, LP (Walmart Pharmacy 10-0044)
• Anna Marie Walker, LPC
• Pamela J Wall, LMT
• Christine Jo Warden, RN
• Ladonna B Wells

• Psychiatric/Mental Health Nurse Practitioner in Eldon, MO
• Providers in Eldon, MO by specialty
• Psychiatric/Mental Health Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2021; 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.