Healthcare Provider Details

I. General information

NPI: 1356227367
Provider Name (Legal Business Name): MR. JEREMY SCHMIDT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 S NATIONAL AVE
SPRINGFIELD MO
65807-5210
US

IV. Provider business mailing address

1645 W WALNUT LAWN ST APT 513
SPRINGFIELD MO
65807-4362
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-5988
  • Fax:
Mailing address:
  • Phone: 618-207-9618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2022039424
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: