Jerrilyn D Adkisson

Primary specialty

Point of ServiceTaxonomy code 305S00000X

Legal business name

JERRILYN D ADKISSON

Practice address

24777 State Hwy 25
Advance, MO 63730

Phone

(573) 722-5200

Fax

(573) 722-5200

NPI assigned

May 18, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Jerrilyn Diane Adkisson

Title

Owner

Phone

(573) 722-5200

Specialties & licenses 1

Addresses

Other names 1

• Paradise Homes Other name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1063620565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24777 STATE HWY 25",
            "city": "ADVANCE",
            "state": "MO",
            "postal_code": "63730",
            "telephone_number": "573-722-5200",
            "fax_number": "573-722-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24777 STATE HWY 25",
            "city": "ADVANCE",
            "state": "MO",
            "postal_code": "63730",
            "telephone_number": "573-722-5200",
            "fax_number": "573-722-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERRILYN D ADKISSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ADKISSON",
        "authorized_official_first_name": "JERRILYN",
        "authorized_official_middle_name": "DIANE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "573-722-5200",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Paradise Homes",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Point of Service in Advance, MO
• Providers in Advance, MO by specialty
• Point of Service in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.