Healthcare Provider Details

I. General information

NPI: 1609574029
Provider Name (Legal Business Name): OHARA STELLAR HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2023
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11124 W 109TH TER
OVERLAND PARK KS
66210-1202
US

IV. Provider business mailing address

11124 W 109TH TER
OVERLAND PARK KS
66210-1202
US

V. Phone/Fax

Practice location:
  • Phone: 618-518-0872
  • Fax:
Mailing address:
  • Phone: 618-518-0872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JAMES O'HARA
Title or Position: OWNER
Credential: APRN
Phone: 618-518-0872