Healthcare Provider Details

I. General information

NPI: 1831152370
Provider Name (Legal Business Name): JEFFERY ALAN KERR D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 GW LN
WAYNESVILLE MO
65583-2339
US

IV. Provider business mailing address

1050 W 10TH ST
ROLLA MO
65401-2905
US

V. Phone/Fax

Practice location:
  • Phone: 573-842-4116
  • Fax: 573-433-2008
Mailing address:
  • Phone: 573-364-9000
  • Fax: 573-426-2108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR8F45
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: