Healthcare Provider Details

I. General information

NPI: 1770311284
Provider Name (Legal Business Name): KASSIE COLLEEN STOCK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2721 SE 10TH ST
TOPEKA KS
66607-1706
US

IV. Provider business mailing address

4133 SE CORINTH CT
TECUMSEH KS
66542-2618
US

V. Phone/Fax

Practice location:
  • Phone: 785-783-8453
  • Fax:
Mailing address:
  • Phone: 785-713-2908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-83419-042
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: