Healthcare Provider Details

I. General information

NPI: 1114763158
Provider Name (Legal Business Name): KAYLA THERESE JARRETT PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 04/17/2025
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 FOREST PARK AVE DEPT NEUROLOGICAL SURGERY, STE 1B
SAINT LOUIS MO
63108-2114
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-3577
  • Fax: 314-362-2107
Mailing address:
  • Phone: 314-362-3577
  • Fax: 314-362-2107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2024009564
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: