Jeremy Ray Tjarks, MS, LAT, ATC

Primary specialty

Other Specialist/TechnologistTaxonomy code 246Z00000X

License

2009024749 Issued in MO

Practice address

2135 S Fremont Ave
Springfield, MO 65804-2239

Phone

(417) 820-7990

NPI assigned

May 1, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1335830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335830400000",
    "number": "1992063697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2349 W NOTTINGHAM ST",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658102298",
            "telephone_number": "417-761-3210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2135 S FREMONT AVE",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658042239",
            "telephone_number": "417-820-7990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TJARKS",
        "first_name": "JEREMY",
        "middle_name": "RAY",
        "name_prefix": "Mr.",
        "credential": "MS, LAT, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-01",
        "last_updated": "2012-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246Z00000X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other",
            "state": "MO",
            "license": "2009024749",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIONAL ATHLETIC TRAINERS ASSOCIATION BOARD OF CERTIFICATION NUMBER",
            "identifier": "020602071",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MISSOURI STATE BOARD OF LICENSER",
            "identifier": "2009024749",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Other Specialist/Technologist in Springfield, MO
• Providers in Springfield, MO by specialty
• Other Specialist/Technologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2012; 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.