MEDICARE: MS. STEPHANIE LEA FOX PA

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	2015004692	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2015004692	OTHER	MO	STATE LICENSE

General Provider Information

NPI Number	:	1487617742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STEPHANIE LEA FOX PA

Provider Business Mailing Address
First Line	:	3231 S NATIONAL AVE STE 300
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-7304
Country	:	US
Telephone Number	:	417-888-5658
Fax Number	:

Provider Business Practice Location Address
First Line	:	3231 S NATIONAL AVE STE 300
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-7304
Country	:	US
Telephone Number	:	417-888-5658
Fax Number	:

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

Provider Enumeration Date	:	04/08/2006
Last Update Date	:	03/07/2022

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