Provider Demographics
NPI:1598472912
Name:EAST, ELIZABETH ANNE (PA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNE
Last Name:EAST
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANNE
Other - Last Name:JANKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 N MORLEY ST STE A115
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-3666
Mailing Address - Country:US
Mailing Address - Phone:660-372-9595
Mailing Address - Fax:660-372-9596
Practice Address - Street 1:1600 N MORLEY ST STE A115
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-3666
Practice Address - Country:US
Practice Address - Phone:660-372-9595
Practice Address - Fax:660-372-9595
Is Sole Proprietor?:No
Enumeration Date:2022-11-04
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
MO2023002004363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant