Provider Demographics
NPI:1396147161
Name:ARTER, JERRY (HIS)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:ARTER
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 N MORLEY ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-2790
Mailing Address - Country:US
Mailing Address - Phone:660-263-7343
Mailing Address - Fax:660-263-3584
Practice Address - Street 1:1011 N MORLEY ST
Practice Address - Street 2:SUITE B
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-2790
Practice Address - Country:US
Practice Address - Phone:660-263-7343
Practice Address - Fax:660-263-3584
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002005867237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist