MEDICARE: JERI L MARKWORTH

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	251C00000X	Developmentally Disabled Services Day Training Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255655114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERI L MARKWORTH

Provider Business Mailing Address
First Line	:	7539 E GEARY DOME RD
Second Line	:
City	:	EVANSVILLE
State	:	WY
Zip	:	82636-9692
Country	:	US
Telephone Number	:	307-797-0827
Fax Number	:

Provider Business Practice Location Address
First Line	:	7539 E GEARY DOME RD
Second Line	:
City	:	EVANSVILLE
State	:	WY
Zip	:	82636-9692
Country	:	US
Telephone Number	:	307-797-0827
Fax Number	:

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

Provider Enumeration Date	:	03/22/2010
Last Update Date	:	03/22/2010

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Directions to “ JERI L MARKWORTH ” Practice Location

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