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Individual

TERESA BARR JOLLEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
108 S HICKORY ST, MOUNT VERNON, MO 65712-1407
(417) 466-4110
(417) 466-4255
Mailing address
PO BOX 802843, KANSAS CITY, MO 64180-2843
(417) 269-5712
(417) 269-7567

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
TC156
KY
363AM0700X
Medical Physician Assistant
2006006813
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
207076
BLUE CROSS OF MO
Enumeration date
09/26/2006
Last updated
03/20/2024
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