Healthcare Provider Details

I. General information

NPI: 1306624754
Provider Name (Legal Business Name): STEPHANIE ELIZABETH FORD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 09/18/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 EUCLID AVE
KANSAS CITY MO
64124-2323
US

IV. Provider business mailing address

13302 W 130TH ST
OVERLAND PARK KS
66213-2336
US

V. Phone/Fax

Practice location:
  • Phone: 815-474-4920
  • Fax:
Mailing address:
  • Phone: 316-573-2717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2023037610
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: