Healthcare Provider Details

I. General information

NPI: 1437149903
Provider Name (Legal Business Name): LEA ANNETTE BAILEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEA A STROUD PA-C

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 E SEMINOLE ST STE A1
SPRINGFIELD MO
65804-2454
US

IV. Provider business mailing address

1675 E SEMINOLE ST STE A1
SPRINGFIELD MO
65804-2454
US

V. Phone/Fax

Practice location:
  • Phone: 417-557-2355
  • Fax: 417-530-1455
Mailing address:
  • Phone: 417-557-2355
  • Fax: 417-530-1455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2004006987
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: