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General NPI Number Information
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NPI Number | 1356227367
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Entity Type | Individual
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Provider Name | MR. JEREMY SCHMIDT
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Gender | Male
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Dates
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Enumeration Date | 08/14/2025
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 3801 S NATIONAL AVE
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City | SPRINGFIELD
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State | MO
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Zip | 65807-5210
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Country | US
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Telephone | 417-269-5988
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Fax |
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Provider Business Mailing Address
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Address Line | 1645 W WALNUT LAWN ST APT 513
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City | SPRINGFIELD
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State | MO
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Zip | 65807-4362
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Country | US
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Telephone | 618-207-9618
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 2022039424
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License Number State | MO
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