Provider Demographics
NPI:1124094719
Name:ABLORDEPPEY, JOY H (MD)
Entity type:Individual
Prefix:DR
First Name:JOY
Middle Name:H
Last Name:ABLORDEPPEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:JOY
Other - Middle Name:H
Other - Last Name:AMEMORNU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1800 COMMUNITY
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735-8804
Mailing Address - Country:US
Mailing Address - Phone:888-403-1071
Mailing Address - Fax:
Practice Address - Street 1:19515 BRUNE PKWY
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:MO
Practice Address - Zip Code:63383-6505
Practice Address - Country:US
Practice Address - Phone:844-853-8937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84456207Q00000X
MO2018040491207Q00000X
GA52126207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268619800Medicaid
82671AMedicare ID - Type Unspecified
FL268619800Medicaid