Individual
AYESHA FATIMA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
932 E 34TH ST, JOPLIN, MO 64804-3932
(417) 347-7600
Mailing address
PO BOX 2526, JOPLIN, MO 64803-2526
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
2024032007
MO
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
2024032007
MO
Other
Enumeration date
08/08/2024
Last updated
08/08/2024
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