Provider Demographics
NPI:1043829989
Name:STUTESMAN, SHARITA
Entity Type:Individual
Prefix:
First Name:SHARITA
Middle Name:
Last Name:STUTESMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 ROAD 30
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:KS
Mailing Address - Zip Code:66860-8906
Mailing Address - Country:US
Mailing Address - Phone:785-824-8017
Mailing Address - Fax:
Practice Address - Street 1:420 W 15TH AVE
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-5367
Practice Address - Country:US
Practice Address - Phone:620-342-4864
Practice Address - Fax:620-343-3545
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS144566163W00000X
KS81472363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse