Healthcare Provider Details

I. General information

NPI: 1104775493
Provider Name (Legal Business Name): ALEXANDER K GERRY PLPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 S MAIN AVE
BOLIVAR MO
65613-2052
US

IV. Provider business mailing address

PO BOX 844715
KANSAS CITY MO
64184-4715
US

V. Phone/Fax

Practice location:
  • Phone: 417-761-5920
  • Fax: 417-761-5921
Mailing address:
  • Phone: 417-761-5214
  • Fax: 417-761-5065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2026016280
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: