Healthcare Provider Details

I. General information

NPI: 1588912828
Provider Name (Legal Business Name): STEPHANIE C MCCLELLAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE C KEARNS CRNA

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8080 E CENTRAL AVE STE 250
WICHITA KS
67206-2368
US

IV. Provider business mailing address

8080 E CENTRAL AVE STE 250
WICHITA KS
67206-2367
US

V. Phone/Fax

Practice location:
  • Phone: 316-686-7327
  • Fax: 316-686-1557
Mailing address:
  • Phone: 316-686-7327
  • Fax: 316-686-1557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number97695
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5384906032
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: