Provider Demographics
NPI:1083090088
Name:THOMASSON, REBECCA SUZANNE ROE (PA-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUZANNE ROE
Last Name:THOMASSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:319 S SILVER SPRINGS RD STE C
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-6308
Mailing Address - Country:US
Mailing Address - Phone:573-334-4263
Mailing Address - Fax:573-334-3699
Practice Address - Street 1:319 S SILVER SPRINGS RD STE C
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-6308
Practice Address - Country:US
Practice Address - Phone:573-334-4263
Practice Address - Fax:573-334-3699
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2015007731363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant