Healthcare Provider Details

I. General information

NPI: 1255702429
Provider Name (Legal Business Name): STEPHANIE DAWN OXANDALE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE DAWN NICHOLS

II. Dates (important events)

Enumeration Date: 10/14/2015
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 CAMBRIDGE ST STE G600
KANSAS CITY KS
66160-8501
US

IV. Provider business mailing address

4000 CAMBRIDGE ST STE G600
KANSAS CITY KS
66160-8501
US

V. Phone/Fax

Practice location:
  • Phone: 913-426-3391
  • Fax:
Mailing address:
  • Phone: 913-426-3391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2015036519
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-76991
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: