Healthcare Provider Details

I. General information

NPI: 1205870433
Provider Name (Legal Business Name): JOHN JEROME BARRETT MS, ATC, CES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JB BARRETT MS, ATC, CES

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 EMERSON RD STE 20
CREVE COEUR MO
63141-6739
US

IV. Provider business mailing address

5316 ZAMORA DR
SAINT LOUIS MO
63128-3520
US

V. Phone/Fax

Practice location:
  • Phone: 314-325-3068
  • Fax: 314-325-3069
Mailing address:
  • Phone: 314-200-9540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL 1824
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2017031789
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: