MEDICARE: MR. JOHN JEROME BARRETT MS, ATC, CES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	AL 1824	FL
2	2255A2300X	Athletic Trainer	2017031789	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2017031789	OTHER	MO	STATE OF MISSOURI ATHLETIC TRAINER LICENSE
2	069702613	OTHER		NATA BOC CERTIFICATION

General Provider Information

NPI Number	:	1205870433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN JEROME BARRETT MS, ATC, CES

Provider Business Mailing Address
First Line	:	5316 ZAMORA DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-3520
Country	:	US
Telephone Number	:	314-200-9540
Fax Number	:

Provider Business Practice Location Address
First Line	:	633 EMERSON RD STE 20
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-6739
Country	:	US
Telephone Number	:	314-325-3068
Fax Number	:	314-325-3069

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	01/24/2019

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