Individual
JONATHON DERRYBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3230 WISCONSIN AVE, JOPLIN, MO 64804-4029
(417) 347-7850
(417) 347-7859
Mailing address
3230 WISCONSIN AVE, JOPLIN, MO 64804-4029
(417) 347-7850
(417) 347-7859
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
04/02/2012
Last updated
04/02/2012
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