Individual
JOEL GIBBONS VICKERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
208 N 9TH ST APT 312, SAINT LOUIS, MO 63101-1437
(314) 713-9144
Mailing address
208 N 9TH ST APT 312, SAINT LOUIS, MO 63101-1437
(314) 713-9144
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
2019042607
MO
Other
Enumeration date
11/13/2021
Last updated
11/13/2021
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