MEDICARE: LISA K FEATHER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	085-000778	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00393085	OTHER	IL	RR MEDICARE NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CE9335	OTHER	IL	RR GROUP NUMBER

General Provider Information

NPI Number	:	1477554228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA K FEATHER PA-C

Provider Business Mailing Address
First Line	:	1601 W ROBINSON
Second Line	:
City	:	WAYNE CITY
State	:	IL
Zip	:	62895-9483
Country	:	US
Telephone Number	:	618-895-3181
Fax Number	:	618-895-3035

Provider Business Practice Location Address
First Line	:	1601 W ROBINSON
Second Line	:
City	:	WAYNE CITY
State	:	IL
Zip	:	62895-9483
Country	:	US
Telephone Number	:	618-895-3181
Fax Number	:	618-895-3035

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	02/26/2026

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Directions to “ LISA K FEATHER PA-C” Practice Location

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