Healthcare Provider Details

I. General information

NPI: 1033706619
Provider Name (Legal Business Name): STEPHANIE RAYCHAEL HULSE NP-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE RAYCHAEL NOLAND

II. Dates (important events)

Enumeration Date: 12/29/2020
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9119 W 74TH ST STE 350
SHAWNEE MISSION KS
66204-2268
US

IV. Provider business mailing address

9119 W 74TH ST STE 350
SHAWNEE MISSION KS
66204-2268
US

V. Phone/Fax

Practice location:
  • Phone: 913-632-9400
  • Fax: 913-632-9444
Mailing address:
  • Phone: 913-632-9400
  • Fax: 913-632-9444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2020042549
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-81061
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: