Healthcare Provider Details

I. General information

NPI: 1346341658
Provider Name (Legal Business Name): TERESA BARR JOLLEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERESA M BARR

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 S HICKORY ST
MOUNT VERNON MO
65712-1407
US

IV. Provider business mailing address

PO BOX 802843
KANSAS CITY MO
64180-2843
US

V. Phone/Fax

Practice location:
  • Phone: 417-466-4110
  • Fax: 417-466-4255
Mailing address:
  • Phone: 417-269-5712
  • Fax: 417-269-7567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberTC156
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2006006813
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: