Provider Demographics
NPI:1649056276
Name:TERRY, JEFFREY (CRNA)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:TERRY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12928 COUNTY ROAD 227
Mailing Address - Street 2:
Mailing Address - City:ORONOGO
Mailing Address - State:MO
Mailing Address - Zip Code:64855-9360
Mailing Address - Country:US
Mailing Address - Phone:417-396-3283
Mailing Address - Fax:
Practice Address - Street 1:1102 W 32ND ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3503
Practice Address - Country:US
Practice Address - Phone:417-347-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023036826367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered