Healthcare Provider Details

I. General information

NPI: 1093637563
Provider Name (Legal Business Name): JERMAYOR ALLRED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 101ST TER STE 350
KANSAS CITY MO
64131-5310
US

IV. Provider business mailing address

5831 SIR EDWARD LN
FLORISSANT MO
63033-7846
US

V. Phone/Fax

Practice location:
  • Phone: 816-371-4180
  • Fax:
Mailing address:
  • Phone: 636-541-3311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-549381
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: