Healthcare Provider Details

I. General information

NPI: 1285038562
Provider Name (Legal Business Name): PAIGE M LOVELACE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2014
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1287 N MAIN ST
PROVIDENCE RI
02904-1856
US

IV. Provider business mailing address

1805 NW PLATTE RD STE 120
RIVERSIDE MO
64150-7500
US

V. Phone/Fax

Practice location:
  • Phone: 401-272-2724
  • Fax: 401-272-2784
Mailing address:
  • Phone: 816-472-0400
  • Fax: 816-472-0813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00923
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: