Individual
AMBERLY TAITE EVERSOLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
960 E WALNUT LAWN ST STE 201, SPRINGFIELD, MO 65807-7865
(417) 269-4450
(417) 269-8333
Mailing address
PO BOX 505673, SAINT LOUIS, MO 63150-5673
(417) 730-6430
(417) 269-7567
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
2024004719
MO
Other
Enumeration date
02/08/2024
Last updated
04/26/2024
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