# JOSETTA ELIESE WAHWASSUCK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1629049929
- **Gender:** F
- **Credential:** MSN, FNP, PMHNP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LF0000X | Family Nurse Practitioner | 096721 | MO | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 096721 | MO | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 44870 | KS | — |

## Other

- **Enumeration date:** 01/27/2006
- **Last updated:** 06/28/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 29929044 | BLUE CROSS BLUE SHIELD | — |
| 05 | — | 423989722 | — | MO |
| 01 | — | P00430963 | RAILROAD MEDICARE | — |