Healthcare Provider Details

I. General information

NPI: 1174060495
Provider Name (Legal Business Name): STEPHANIE MARIE BETSWORTH APRN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE MARIE TALLEY

II. Dates (important events)

Enumeration Date: 01/24/2017
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 NW BLUE PKWY
LEES SUMMIT MO
64086-5713
US

IV. Provider business mailing address

15710 W 135TH ST STE 200
OLATHE KS
66062-1508
US

V. Phone/Fax

Practice location:
  • Phone: 913-297-7472
  • Fax:
Mailing address:
  • Phone: 913-297-7472
  • Fax: 913-764-0336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number77536
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2022005296
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: