Healthcare Provider Details

I. General information

NPI: 1417386426
Provider Name (Legal Business Name): JEREMY DAVID TURK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2013
Last Update Date: 11/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 S ASH ST
NEVADA MO
64772-3222
US

IV. Provider business mailing address

1322 W STATE ST
SPRINGFIELD MO
65806-2754
US

V. Phone/Fax

Practice location:
  • Phone: 417-667-8352
  • Fax: 417-667-9216
Mailing address:
  • Phone: 417-773-0853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: