Basic Information
| Provider Information | |||||||||
| NPI: | 1407350564 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATTOON | ||||||||
| FirstName: | JOCELYN | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1133 COLLEGE AVE STE E110 | ||||||||
| Address2: | |||||||||
| City: | MANHATTAN | ||||||||
| State: | KS | ||||||||
| PostalCode: | 665022813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7855372651 | ||||||||
| FaxNumber: | 7855374276 | ||||||||
| Practice Location | |||||||||
| Address1: | 1133 COLLEGE AVE STE E110 | ||||||||
| Address2: | |||||||||
| City: | MANHATTAN | ||||||||
| State: | KS | ||||||||
| PostalCode: | 665022813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7855372651 | ||||||||
| FaxNumber: | 7855374276 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2018 | ||||||||
| LastUpdateDate: | 10/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 04-42640 | KS | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | 01082945A | IN | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.