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NPI Code Detail

MEDICARE: KEONA LEE STEPHENS FNP

MEDICARE: KEONA LEE STEPHENS FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner2000146246MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12000146246OTHERMOFNP LICENSE

General Provider Information

NPI Number : 1194796003
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEONA LEE STEPHENS FNP
Provider Business Mailing Address
First Line : 825 EUCLID AVE
Second Line :
City : KANSAS CITY
State : MO
Zip : 64124-2323
Country : US
Telephone Number : 816-474-4920
Fax Number : 816-474-4914
Provider Business Practice Location Address
First Line : 825 EUCLID AVE
Second Line :
City : KANSAS CITY
State : MO
Zip : 64124-2323
Country : US
Telephone Number : 816-474-4920
Fax Number : 816-474-4914
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2006
Last Update Date : 12/01/2011

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