Provider Demographics
NPI:1164666772
Name:ASMUSSEN, STACY M (PA)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:M
Last Name:ASMUSSEN
Suffix:
Gender:F
Credentials:PA
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Other - Last Name:
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Mailing Address - Street 1:9350 E 35TH ST N
Mailing Address - Street 2:STE 101
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2019
Mailing Address - Country:US
Mailing Address - Phone:316-265-1308
Mailing Address - Fax:316-265-4480
Practice Address - Street 1:9350 E 35TH ST N
Practice Address - Street 2:STE 101
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2019
Practice Address - Country:US
Practice Address - Phone:316-265-1308
Practice Address - Fax:316-265-4480
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2021-03-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS15-00774363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical