Individual
MRS. MADISON LANE FUGATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2861 NE INDEPENDENCE AVE STE 201, LEES SUMMIT, MO 64064-2379
(816) 525-2840
Mailing address
2861 NE INDEPENDENCE AVE STE 201, LEES SUMMIT, MO 64064-2379
(816) 525-2840
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2021046816
MO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/09/2021
Last updated
02/02/2022
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