Joyce Theard
Individual provider Active NPI Prevention Professional · Berkeley, MO
NPI 1730666017 · NPPES record last updated Jul 19, 2018
Key facts
- NPI
- 1730666017
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Prevention Professional 405300000X
- License
- SE103 (MO)
- Practice address
- 6121 N Hanley Rd
Berkeley, MO 63134-2003 - Phone
- (314) 615-6415
- Fax
- (314) 615-6415
- NPI assigned
- Jul 19, 2018
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SE103 | MO | MD | Prevention Professional |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prevention Professional |
405300000X | SE103 | MO | Yes |
Addresses
Primary practice location
6121 N Hanley Rd
Berkeley, MO 63134-2003
Mailing address
6121 N Hanley Rd
Berkeley, MO 63134-2003
Phone (314) 615-6415
Other providers in Berkeley, MO
- Bernadette Sheffield
- Cayla Christine Slaughter
- Philip Snipes
- Jeffrey Duane Snyder
- St. Louis County Government
- Courtney Tiemann
- Naomi N. Vance
- Erica Wilkins
- Sarah Woods
All providers in Berkeley, MO · Prevention Professional in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 19, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.