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NPI Code Detail

MEDICARE: JERRICA RUSSELL PA-C

MEDICARE: JERRICA RUSSELL PA-C
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
1363A00000XPhysician Assistant2026009997MO

General Provider Information

NPI Number : 1588519920
Entity Type Code : Individual
Provider Name (Legal Business Name) : JERRICA RUSSELL PA-C
Provider Business Mailing Address
First Line : 1150 STATE HIGHWAY 248
Second Line :
City : BRANSON
State : MO
Zip : 65616-3758
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1150 STATE HIGHWAY 248 STE 200
Second Line :
City : BRANSON
State : MO
Zip : 65616-4186
Country : US
Telephone Number : 417-336-4112
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2026
Last Update Date : 05/20/2026

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Directions to “ JERRICA RUSSELL PA-C” Practice Location

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