Jacob Ryan Kent

Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Fayette, MO

NPI 1841702685 · NPPES record last updated Nov 2, 2017

Key facts

NPI
1841702685
Entity type
Individual (NPI type 1)
Primary specialty
Student in an Organized Health Care Education/Training Program 390200000X
Practice address
411 Central Methodist SQ
Fayette, MO 65248-1104
Phone
(573) 544-5902
NPI assigned
Nov 2, 2017
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X
Student in an Organized Health Care Education/Training Program 390200000X Yes

Addresses

Primary practice location

411 Central Methodist SQ
Fayette, MO 65248-1104

Mailing address

305 N Broadwater St
New Florence, MO 63363-1232

Other providers in Fayette, MO

All providers in Fayette, MO · Student in an Organized Health Care Education/Training Program in Missouri

Sources for this page

Verify at the official NPI Registry.