Provider Demographics
NPI:1215643713
Name:MACFEE, HAVEN (PA-C)
Entity type:Individual
Prefix:
First Name:HAVEN
Middle Name:
Last Name:MACFEE
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 1:940 W MOUNT VERNON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-9613
Mailing Address - Country:US
Mailing Address - Phone:417-724-5300
Mailing Address - Fax:
Practice Address - Street 1:940 W MOUNT VERNON ST STE 100
Practice Address - Street 2:
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-9613
Practice Address - Country:US
Practice Address - Phone:417-724-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-27
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023006633363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant