| Doctor Name: | JOYCE E PETERSON |
| NPI Number: | 1649376161 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 0792008 |
| Business Practice Address: | 1900 S Broadway Box 670 Oak Grove, MO - 64075 |
| Business Phone Number: | 8166906566 |
| Business Fax Number: | 8166258276 |
| Mailing Address: | 1900 S Broadway, Box 670 OAK GROVE |
| State: | MO |
| Postal Code: | 64075 |
| Phone Number: | 8166906566 |
| Fax Number: | 8166258276 |
| NPI Enumeration Date: | 09/15/2006 |
| NPI Last Update Date: | 09/21/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 0792008 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |