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General NPI Number Information
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NPI Number | 1275857575
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Entity Type | Organization
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Legal Business Name | E KENT STEVENSON MD PC
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Dates
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Enumeration Date | 03/16/2010
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Last Update Date | 04/22/2010
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Provider Practice Location Address
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Address Line | 5200 W 94TH TER SUITE 105
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66207-2522
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Country | US
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Telephone | 913-649-5567
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Fax | 913-649-7563
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Provider Business Mailing Address
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Address Line | 5200 W 94TH TER SUITE 105
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66207-2522
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Country | US
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Telephone | 913-649-5567
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Fax | 913-649-7563
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Authorized Official
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Title or Position | PRESIDENT
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Name | EDWARD KENT STEVENSON
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Credential | M.D.
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Telephone | 913-649-5567
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0415789
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License Number State | KS
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