Provider Demographics
NPI:1114763158
Name:JARRETT, KAYLA THERESE (PA)
Entity type:Individual
Prefix:MS
First Name:KAYLA
Middle Name:THERESE
Last Name:JARRETT
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Gender:
Credentials:PA
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Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-362-3577
Mailing Address - Fax:314-362-2107
Practice Address - Street 1:4500 FOREST PARK AVE
Practice Address - Street 2:DEPT NEUROLOGICAL SURGERY, STE 1B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2114
Practice Address - Country:US
Practice Address - Phone:314-362-3577
Practice Address - Fax:314-362-2107
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2024009564363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO220143245Medicaid