=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346184124
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAKAYLA JOB
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2026
-----------------------------------------------------
Last Update Date | 04/14/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1150 STATE HIGHWAY 248 STE 200
-----------------------------------------------------
City | BRANSON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65616-4186
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-336-4112
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2042 N JEFFERSON AVE
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65803-2924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-318-4047
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 2026006193
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------