Provider Demographics
NPI:1801803408
Name:HERRINGTON, JESSE LEE (AT)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:LEE
Last Name:HERRINGTON
Suffix:
Gender:M
Credentials:AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:MISSOURI STATE UNIVERSITY ATHLETIC TRAINING SERVICES
Mailing Address - Street 2:901 S. NATIONAL
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65897-0001
Mailing Address - Country:US
Mailing Address - Phone:417-836-5461
Mailing Address - Fax:417-836-6101
Practice Address - Street 1:MISSOURI STATE UNIVERSITY ATHLETIC TRAINING SERVICES
Practice Address - Street 2:901 S. NATIONAL
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65897-0001
Practice Address - Country:US
Practice Address - Phone:417-836-5461
Practice Address - Fax:417-836-6101
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20060223702255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2006022370OtherMO LICENSURE