Individual
STEPHANIE ELIZABETH MATHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
505 N 25TH ST, OZARK, MO 65721-9069
(417) 581-3548
Mailing address
505 N 25TH ST, OZARK, MO 65721-9069
(417) 581-3548
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2012002972
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
431560263
TRICARE
MO
01
—
P01095871
RR MCR
MO
Enumeration date
02/08/2012
Last updated
07/21/2020
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