Individual
TRACI N ST CLAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C.
Contact information
Practice address
1229 E SEMINOLE ST, SPRINGFIELD, MO 65804-2227
(417) 820-5610
(417) 820-5588
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
2003002310
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2003002310
STATE LICENSE
MO
Enumeration date
04/06/2006
Last updated
07/22/2008
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