Provider Demographics
NPI:1255492633
Name:CALDWELL, STEPHANIE LYNN (PA)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:LYNN
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:LYNN
Other - Last Name:BARNABY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3901 RAINBOW BLVD
Mailing Address - Street 2:MS 3017
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160
Mailing Address - Country:US
Mailing Address - Phone:913-588-6100
Mailing Address - Fax:913-588-8186
Practice Address - Street 1:7405 RENNER ROAD
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66217
Practice Address - Country:US
Practice Address - Phone:913-588-6100
Practice Address - Fax:913-588-8186
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00918363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1060213OtherNCCPA
KS200634930Medicaid
Q39540Medicare UPIN