Individual
MR. JEREMY RAY TJARKS
Active
Individual
MR. JEREMY RAY TJARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, LAT, ATC
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
2009024749
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020602071
NATIONAL ATHLETIC TRAINERS ASSOCIATION BOARD OF CERTIFICATION NUMBER
—
01
—
2009024749
MISSOURI STATE BOARD OF LICENSER
MO
Enumeration date
05/01/2012
Last updated
05/01/2012
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