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General NPI Number Information
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NPI Number | 1922578996
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Entity Type | Individual
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Provider Name | MRS. JERRILYN DIANE ADKISSON
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Gender | Female
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Dates
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Enumeration Date | 12/03/2018
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Last Update Date | 12/03/2018
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Provider Practice Location Address
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Address Line | 208 N INGRAM RD
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City | SIKESTON
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State | MO
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Zip | 63801-5233
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Country | US
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Telephone | 573-471-3770
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Fax |
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Provider Business Mailing Address
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Address Line | 208 N INGRAM RD
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City | SIKESTON
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State | MO
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Zip | 63801-5233
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Country | US
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Telephone | 573-471-3770
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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 | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State | MO
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