MEDICARE: MS. STACEY SCHULTZ MPAS, PA-C

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
1	363A00000X	Physician Assistant	15-01899	KS
2	363A00000X	Physician Assistant	2016024307	MO

General Provider Information

NPI Number	:	1235685975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STACEY SCHULTZ MPAS, PA-C

Provider Business Mailing Address
First Line	:	8490 COLLEGE BOULEVARD
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66210-2123
Country	:	US
Telephone Number	:	913-722-5551
Fax Number	:

Provider Business Practice Location Address
First Line	:	5330 NORTH OAK TRFWY
Second Line	:	SUITE 201
City	:	KANSAS CITY
State	:	MO
Zip	:	64118-4600
Country	:	US
Telephone Number	:	816-454-0666
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	09/01/2016

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