Healthcare Provider Details

I. General information

NPI: 1952362048
Provider Name (Legal Business Name): KERSTIN LEIGH STEPHENS PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 RAINBOW BLVD MAIL STOP 1042
KANSAS CITY KS
66160
US

IV. Provider business mailing address

3901 RAINBOW BLVD MAIL STOP 1042
KANSAS CITY KS
66160
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-6022
  • Fax: 913-535-2101
Mailing address:
  • Phone: 913-588-6022
  • Fax: 913-588-4060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1500845
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2009017044
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: