Provider Demographics
NPI:1346951035
Name:PETERS, STEPHANIE LYNNE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LYNNE
Last Name:PETERS
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:2401 GILLHAM RD
Mailing Address - Street 2:ATTN: PROVIDER ENROLLMENT DEPARTMENT
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-4619
Mailing Address - Country:US
Mailing Address - Phone:816-701-5200
Mailing Address - Fax:816-302-9939
Practice Address - Street 1:8800 W 75TH ST STE 220
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-4001
Practice Address - Country:US
Practice Address - Phone:913-384-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2023-12-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2016008013163WP0200X
KS14-135063-101163WP0200X
KS53-81819-101363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WP0200XNursing Service ProvidersRegistered NursePediatrics