Provider Demographics
NPI:1083133771
Name:KLEMP, MARY JOAN (MED, RN, MSM, CCM)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:JOAN
Last Name:KLEMP
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Gender:F
Credentials:MED, RN, MSM, CCM
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Mailing Address - Street 1:GENERAL LEONARD WOOD ARMY COMMUNITY HOSPITAL
Mailing Address - Street 2:4430 MISSOURI AVE; MEDDAC CASE MANAGEMENT
Mailing Address - City:FORT LEONARD WOOD
Mailing Address - State:MO
Mailing Address - Zip Code:65473
Mailing Address - Country:US
Mailing Address - Phone:573-596-7715
Mailing Address - Fax:573-596-9588
Practice Address - Street 1:GANERAL LEONARD WOOD ARMY COMMUNITY HOSPITAL
Practice Address - Street 2:4430 MISSOURI AVE; MEDDAC CASE MANAGEMENT; PRIMARY CARE
Practice Address - City:FORT LEONARD WOOD
Practice Address - State:MO
Practice Address - Zip Code:65473
Practice Address - Country:US
Practice Address - Phone:573-596-0540
Practice Address - Fax:573-596-5342
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2022-04-06
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Provider Licenses
StateLicense IDTaxonomies
MO2005024694163WC0400X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine