Healthcare Provider Details

I. General information

NPI: 1700695962
Provider Name (Legal Business Name): HEATHER R CAUSEY CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 CUMBERLAND RD
ELKLAND MO
65644-7269
US

IV. Provider business mailing address

424 CUMBERLAND RD
ELKLAND MO
65644-7269
US

V. Phone/Fax

Practice location:
  • Phone: 417-288-3126
  • Fax:
Mailing address:
  • Phone: 417-288-3126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: