Individual
TERRY E CARLISLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1 HOSPITAL DR, COLUMBIA, MO 65212-0001
(573) 882-8091
(573) 884-1902
Mailing address
PO BOX 843966, KANSAS CITY, MO 64184-3966
(573) 884-3300
(573) 884-0943
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
102772
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
114175 & 111238
BLUE SHIELD
MO
01
—
2286899001
KANSAS MEDICAID
MO
01
—
342272
HEALTHLINK
MO
Enumeration date
06/14/2006
Last updated
10/05/2022
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