Healthcare Provider Details

I. General information

NPI: 1346184124
Provider Name (Legal Business Name): MAKAYLA JOB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 STATE HIGHWAY 248 STE 200
BRANSON MO
65616-4186
US

IV. Provider business mailing address

2042 N JEFFERSON AVE
SPRINGFIELD MO
65803-2924
US

V. Phone/Fax

Practice location:
  • Phone: 417-336-4112
  • Fax:
Mailing address:
  • Phone: 573-318-4047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2026006193
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: