Individual
JILL A ENDICOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3202 MCINTOSH CIR, SUITE LL03, JOPLIN, MO 64804-3646
(417) 347-6400
(417) 347-6404
Mailing address
PO BOX 3810, JOPLIN, MO 64803-3810
(417) 347-6400
(417) 347-6404
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2004019593
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
192713
ANTHEM
MO
05
—
200034570A
—
OK
05
—
200265670A
—
KS
05
—
429313307
—
MO
01
—
P00175249
RR MEDICARE
—
Enumeration date
07/03/2006
Last updated
03/16/2015
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