Healthcare Provider Details

I. General information

NPI: 1669977781
Provider Name (Legal Business Name): EMILY KRISTEN STOLL DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29475 W 189TH TER
GARDNER KS
66030-9428
US

IV. Provider business mailing address

29475 W 189TH TER
GARDNER KS
66030-9428
US

V. Phone/Fax

Practice location:
  • Phone: 913-856-5577
  • Fax: 913-856-3907
Mailing address:
  • Phone: 913-856-5577
  • Fax: 913-856-3907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number05-45352
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: