Provider Demographics
NPI:1285038562
Name:LOVELACE, PAIGE M (PA-C)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:M
Last Name:LOVELACE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 NW PLATTE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:MO
Mailing Address - Zip Code:64150-7500
Mailing Address - Country:US
Mailing Address - Phone:816-472-0400
Mailing Address - Fax:816-472-0813
Practice Address - Street 1:1287 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-1856
Practice Address - Country:US
Practice Address - Phone:401-272-2724
Practice Address - Fax:401-272-2784
Is Sole Proprietor?:No
Enumeration Date:2014-10-15
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00923363A00000X
MAPA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant