Healthcare Provider Details

I. General information

NPI: 1467563460
Provider Name (Legal Business Name): TIMMY ALAN FERRELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 FARAON ST
SAINT JOSEPH MO
64506-3488
US

IV. Provider business mailing address

10520 N PAYMENT PEAK RD
HAUSER ID
83854-4524
US

V. Phone/Fax

Practice location:
  • Phone: 816-271-6000
  • Fax:
Mailing address:
  • Phone: 208-619-9334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberM12915
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2017039277
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: