Healthcare Provider Details

I. General information

NPI: 1306434022
Provider Name (Legal Business Name): PAIGE MARIE KASSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAIGE M RAKERS

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17300 N OUTER 40 RD STE 201
CHESTERFIELD MO
63005-1364
US

IV. Provider business mailing address

17300 N OUTER 40 RD STE 201
CHESTERFIELD MO
63005-1364
US

V. Phone/Fax

Practice location:
  • Phone: 636-778-2900
  • Fax: 636-778-2828
Mailing address:
  • Phone: 636-778-2900
  • Fax: 636-778-2828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2022004184
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: