MEDICARE: DR. KIMBERLEE LAUREN YASSA DO

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	207P00000X	Emergency Medicine Physician	2021021947	MO

General Provider Information

NPI Number	:	1902470578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLEE LAUREN YASSA DO

Provider Business Mailing Address
First Line	:	1515 S GLENSTONE AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-1407
Country	:	US
Telephone Number	:	417-833-1100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 S GLENSTONE AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-1407
Country	:	US
Telephone Number	:	417-833-1100
Fax Number	:

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

Provider Enumeration Date	:	05/18/2021
Last Update Date	:	02/02/2026

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