MEDICARE: MS. KERSTIN LEIGH STEPHENS PAC

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	363AS0400X	Surgical Physician Assistant	1500845	KS
2	363A00000X	Physician Assistant	2009017044	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952362048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KERSTIN LEIGH STEPHENS PAC

Provider Business Mailing Address
First Line	:	3901 RAINBOW BLVD
Second Line	:	MAIL STOP 1042
City	:	KANSAS CITY
State	:	KS
Zip	:	66160
Country	:	US
Telephone Number	:	913-588-6022
Fax Number	:	913-588-4060

Provider Business Practice Location Address
First Line	:	3901 RAINBOW BLVD
Second Line	:	MAIL STOP 1042
City	:	KANSAS CITY
State	:	KS
Zip	:	66160
Country	:	US
Telephone Number	:	913-588-6022
Fax Number	:	913-535-2101

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

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	04/23/2019

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