Dr Jerrell Lee Driver, PHD is a
Psychologist - Clinical based in Jackson, Missouri. Dr Jerrell Lee Driver is licensed to practice in Missouri (license number PY 00099) and his current practice location is
2387 W Jackson Blvd, Suite B, Jackson, Missouri. He can be reached at his office (for appointments etc.) via phone at
(573) 204-7771.
NPI number for Dr Jerrell Lee Driver is 1912908963 and his current mailing address is Post Office Box 1642, Cape Girardeau, Missouri. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1912908963.
Healthcare Provider's Profile
| Full Name | Dr Jerrell Lee Driver |
|---|
| Gender | Male |
|---|
| Speciality | Psychologist - Clinical |
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| Location | 2387 W Jackson Blvd, Jackson, Missouri |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1912908963
- Provider Enumeration Date: 08/02/2005
- Last Update Date: 09/10/2011
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
NOT enrolled with medicare and thus cannot 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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