Individual
STACEY A LEITHLITER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
7 S HOSPITAL DR, MURPHYSBORO, IL 62966-3333
(618) 687-3418
Mailing address
PO BOX 577, CARTERVILLE, IL 62918-0577
(618) 985-8221
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
363AM0700X
Medical Physician Assistant
085000393
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085000393
STATE LICENSE NUMBER
IL
Enumeration date
01/09/2007
Last updated
01/25/2023
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