Dr Jerrell Lee Driver, PHD is a medicare enrolled "Psychologist - Clinical" provider in Jackson, Missouri. His current practice location is
2387 W Jackson Blvd, Suite B, Jackson, Missouri. You can reach out to his office (for appointments etc.) via phone at
(573) 204-7771.
Dr Jerrell Lee Driver is licensed to practice in Missouri (license number PY 00099) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1912908963.
Healthcare Provider's Profile
| Full Name | Dr Jerrell Lee Driver |
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| Gender | Male |
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| Speciality | Psychologist - Clinical |
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| Location | 2387 W Jackson Blvd, Jackson, Missouri |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1912908963
- Provider Enumeration Date: 08/02/2005
- Last Update Date: 09/10/2011
Medicare PECOS Information:
- PECOS PAC ID: 9234305756
- Enrollment ID: I20120105000342
Medical Identifiers
Medical identifiers for Dr Jerrell Lee Driver such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1912908963 | NPI | - | NPPES |
| PY00099 | Other | | MO-LICENSE PSYCHOLOGIST |
| 493204309 | Medicaid | MO | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 103TC0700X | Psychologist - Clinical | PY 00099 (Missouri) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Jerrell Lee Driver is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Jerrell Lee Driver, PHD
Post Office Box 1642,
Cape Girardeau, MO 63702-1642
Ph: (573) 204-7771 | Dr Jerrell Lee Driver, PHD
2387 W Jackson Blvd, Suite B,
Jackson, MO 63755-3024
Ph: (573) 204-7771 |
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