Provider Demographics
NPI:1447217468
Name:STEVENS, LINLY C (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LINLY
Middle Name:C
Last Name:STEVENS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 W 109TH ST
Mailing Address - Street 2:SUITE 116
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1313
Mailing Address - Country:US
Mailing Address - Phone:913-469-1115
Mailing Address - Fax:913-469-9446
Practice Address - Street 1:4601 W 109TH ST
Practice Address - Street 2:SUITE 116
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1313
Practice Address - Country:US
Practice Address - Phone:913-469-1115
Practice Address - Fax:913-469-9446
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00836363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSP00122609OtherMEDICARE RAILROAD
KSJ41C891Medicare PIN
KSQ12198Medicare UPIN