Healthcare Provider Details

I. General information

NPI: 1396085395
Provider Name (Legal Business Name): MISTY STAMBACH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2013
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4321 WASHINGTON ST STE 3000
KANSAS CITY MO
64111-5928
US

IV. Provider business mailing address

4321 WASHINGTON ST STE 3000
KANSAS CITY MO
64111-5928
US

V. Phone/Fax

Practice location:
  • Phone: 816-932-3100
  • Fax: 816-932-6871
Mailing address:
  • Phone: 816-932-3100
  • Fax: 816-932-6871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2013005694
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: