Individual
JEFFERY ALAN TICHENOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4049 S CAMPBELL AVE, SPRINGFIELD, MO 65807-5303
(417) 890-5550
(417) 890-6429
Mailing address
1632 MISSOURI AVENUE, CARTHAGE, MO 64836-2032
(417) 358-7600
(417) 358-4103
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
109829
MO
Other
Enumeration date
10/31/2006
Last updated
05/22/2015
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