Healthcare Provider Details

I. General information

NPI: 1831556455
Provider Name (Legal Business Name): JENNIFER ANNE BARCLAY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2016
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 MARTIN SPRINGS DR STE 250
ROLLA MO
65401-2980
US

IV. Provider business mailing address

1605 MARTIN SPRINGS DR STE 250
ROLLA MO
65401-2980
US

V. Phone/Fax

Practice location:
  • Phone: 573-458-6363
  • Fax:
Mailing address:
  • Phone: 573-458-6363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR4000
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2023005457
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: