Provider Demographics
NPI:1235721069
Name:LASSITER, HEATHER RENEE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:RENEE
Last Name:LASSITER
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:520 S PORTER AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-3015
Mailing Address - Country:US
Mailing Address - Phone:417-437-0937
Mailing Address - Fax:
Practice Address - Street 1:100 MERCY WAY STE 430
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4524
Practice Address - Country:US
Practice Address - Phone:417-556-8730
Practice Address - Fax:417-556-2277
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS15-02883363A00000X
MO2020007088363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant