MEDICARE: MS. KAYLA THERESE JARRETT PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	2024009564	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114763158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAYLA THERESE JARRETT PA

Provider Business Mailing Address
First Line	:	10012 KENNERLY RD STE 406
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-2197
Country	:	US
Telephone Number	:	314-525-1224
Fax Number	:	314-525-4957

Provider Business Practice Location Address
First Line	:	4500 FOREST PARK AVE
Second Line	:	DEPT NEUROLOGICAL SURGERY, STE 1B
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-2114
Country	:	US
Telephone Number	:	314-362-3577
Fax Number	:	314-362-2107

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2024
Last Update Date	:	03/19/2026

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