Healthcare Provider Details

I. General information

NPI: 1467184275
Provider Name (Legal Business Name): BRIANNA STACK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 WORNALL RD STE 65
KANSAS CITY MO
64111-3201
US

IV. Provider business mailing address

4330 WORNALL RD STE 65
KANSAS CITY MO
64111-3201
US

V. Phone/Fax

Practice location:
  • Phone: 816-932-6100
  • Fax: 816-932-9002
Mailing address:
  • Phone: 816-932-6100
  • Fax: 816-932-9002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2022042946
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2025026899
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: