Healthcare Provider Details

I. General information

NPI: 1174191704
Provider Name (Legal Business Name): STEPHANY BOAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4321 WASHINGTON ST STE 4000
KANSAS CITY MO
64111-5965
US

IV. Provider business mailing address

4321 WASHINGTON ST STE 4000
KANSAS CITY MO
64111-5965
US

V. Phone/Fax

Practice location:
  • Phone: 816-932-6239
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number80084
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: