Provider Demographics
NPI:1508061102
Name:JARBOE, RUSTY TODD
Entity Type:Individual
Prefix:MR
First Name:RUSTY
Middle Name:TODD
Last Name:JARBOE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12735 11TH RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:KS
Mailing Address - Zip Code:67119-9019
Mailing Address - Country:US
Mailing Address - Phone:620-222-1504
Mailing Address - Fax:
Practice Address - Street 1:2800 E 12TH AVE
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-4144
Practice Address - Country:US
Practice Address - Phone:620-262-1441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker