Provider Demographics
NPI:1043212210
Name:YOUNGER, STACY DAWN (MD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:DAWN
Last Name:YOUNGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:STACY
Other - Middle Name:DAWN
Other - Last Name:WHITAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12140 NALL AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2503
Mailing Address - Country:US
Mailing Address - Phone:913-661-9434
Mailing Address - Fax:913-661-4688
Practice Address - Street 1:12140 NALL AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-2503
Practice Address - Country:US
Practice Address - Phone:913-661-9434
Practice Address - Fax:913-661-4688
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04266892084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100446230AMedicaid
KS100446230BMedicaid
MO207860008Medicaid
KS100446230AMedicaid
MO207860008Medicaid
KSG67568Medicare UPIN