Healthcare Provider Details

I. General information

NPI: 1356305759
Provider Name (Legal Business Name): RACHEL A STUCKY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HOSPITAL DR
MCPHERSON KS
67460-2326
US

IV. Provider business mailing address

1000 HOSPITAL DR
MCPHERSON KS
67460-2326
US

V. Phone/Fax

Practice location:
  • Phone: 620-241-7400
  • Fax: 620-798-2613
Mailing address:
  • Phone: 620-241-7400
  • Fax: 620-798-2613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number15-01013
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: