Healthcare Provider Details
I. General information
NPI: 1073221628
Provider Name (Legal Business Name): STEPHANIE PRYOR DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 11/14/2022
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
4525 W 6TH ST STE 100
LAWRENCE KS
66049-7700
US
IV. Provider business mailing address
325 MAINE STREET MSO LIBRARY
LAWRENCE KS
66044
US
V. Phone/Fax
- Phone: 785-505-5160
- Fax: 785-505-5282
- Phone: 785-505-2988
- Fax: 785-505-5228
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363L00000X |
| Taxonomy | Nurse Practitioner |
| License Number | 53-81343-062 |
| License Number State | KS |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207Q00000X |
| Taxonomy | Family Medicine Physician |
| License Number | 81343 |
| License Number State | KS |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: