Individual
KAYLEE VILLASENOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
440 E TAMPA ST, SPRINGFIELD, MO 65806-1131
(417) 831-0150
Mailing address
440 E TAMPA ST, SPRINGFIELD, MO 65806-1131
(417) 831-0150
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2023007276
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
220120973
—
MO
Enumeration date
02/24/2023
Last updated
10/18/2023
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