Healthcare Provider Details

I. General information

NPI: 1083569289
Provider Name (Legal Business Name): STEPHANIE G KLINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 SW 3RD ST
LEES SUMMIT MO
64063-2212
US

IV. Provider business mailing address

621 SW 3RD ST
LEES SUMMIT MO
64063-2212
US

V. Phone/Fax

Practice location:
  • Phone: 816-524-5084
  • Fax:
Mailing address:
  • Phone: 816-524-5084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number2010028716
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: