Healthcare Provider Details

I. General information

NPI: 1770900433
Provider Name (Legal Business Name): STEPHANIE SISK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2014
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 SW GAGE BLVD STE 100
TOPEKA KS
66604-2283
US

IV. Provider business mailing address

1111 SW GAGE BLVD STE 100
TOPEKA KS
66604-2283
US

V. Phone/Fax

Practice location:
  • Phone: 785-329-6282
  • Fax: 888-522-7357
Mailing address:
  • Phone: 785-329-6282
  • Fax: 785-730-2454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number76421
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number76421
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: