Healthcare Provider Details

I. General information

NPI: 1922752369
Provider Name (Legal Business Name): STEVENS SLEEP CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2022
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11881 W 112TH ST
OVERLAND PARK KS
66210-2717
US

IV. Provider business mailing address

6725 LONGVIEW RD
SHAWNEE KS
66218-9284
US

V. Phone/Fax

Practice location:
  • Phone: 913-754-3275
  • Fax:
Mailing address:
  • Phone: 913-244-5805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY SUZANNE STEVENS
Title or Position: OWNER
Credential: MD
Phone: 913-244-5805