Healthcare Provider Details

I. General information

NPI: 1992744585
Provider Name (Legal Business Name): TRACEY LEANN STOVER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 09/29/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1947 N FOUNDERS CIR
WICHITA KS
67206-3548
US

IV. Provider business mailing address

7702 E OAKMOUNT ST
WICHITA KS
67226-3527
US

V. Phone/Fax

Practice location:
  • Phone: 316-613-4600
  • Fax:
Mailing address:
  • Phone: 316-260-3330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number55019
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: