Provider Demographics
NPI:1053452581
Name:CARRIGAN, STEPHANIE JUNE (ARNP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JUNE
Last Name:CARRIGAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 S HILLSIDE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-2154
Mailing Address - Country:US
Mailing Address - Phone:316-682-9900
Mailing Address - Fax:316-682-0311
Practice Address - Street 1:144 S HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-2154
Practice Address - Country:US
Practice Address - Phone:316-682-9900
Practice Address - Fax:316-682-0311
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209006265363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200584900BMedicaid
KSKA2209004Medicare PIN