Provider Demographics
NPI:1235685975
Name:SCHULTZ, STACEY (MPAS, PA-C)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8490 COLLEGE BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2123
Mailing Address - Country:US
Mailing Address - Phone:913-722-5551
Mailing Address - Fax:
Practice Address - Street 1:5330 NORTH OAK TRFWY
Practice Address - Street 2:SUITE 201
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-4600
Practice Address - Country:US
Practice Address - Phone:816-454-0666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01899363A00000X
MO2016024307363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant