Individual
MR. JEREMY RAY TJARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, LAT, ATC
Contact information
Practice address
2135 S FREMONT AVE, SPRINGFIELD, MO 65804-2239
(417) 820-7990
Mailing address
2349 W NOTTINGHAM ST, SPRINGFIELD, MO 65810-2298
(417) 761-3210
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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