Provider Demographics
NPI:1114366754
Name:BROCKMAN, STEFFANY R (RN)
Entity Type:Individual
Prefix:MRS
First Name:STEFFANY
Middle Name:R
Last Name:BROCKMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:STEFFANY
Other - Middle Name:R
Other - Last Name:WOODERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:1253 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64050-4162
Mailing Address - Country:US
Mailing Address - Phone:816-260-6667
Mailing Address - Fax:
Practice Address - Street 1:11661 COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-4107
Practice Address - Country:US
Practice Address - Phone:913-432-8400
Practice Address - Fax:913-432-8402
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002017255163W00000X
KS14107455061163W00000X
KS53-76600-061363LA2200X
MO2014036817363LF0000X, 364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily