Individual
MRS. JERRILYN DIANE ADKISSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
208 N INGRAM RD, SIKESTON, MO 63801-5233
(573) 471-3770
Mailing address
208 N INGRAM RD, SIKESTON, MO 63801-5233
(573) 471-3770
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1063620565
NPI
MO
01
—
LC001488560
MISSOURI SECRETARY OF STATE
MO
Enumeration date
12/03/2018
Last updated
12/03/2018
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