Provider Demographics
NPI:1467684506
Name:STAHL, TRACY L (ARNP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:L
Last Name:STAHL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 N HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:KS
Mailing Address - Zip Code:66743-2000
Mailing Address - Country:US
Mailing Address - Phone:620-724-8291
Mailing Address - Fax:620-724-6332
Practice Address - Street 1:302 N HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:KS
Practice Address - Zip Code:66743-2000
Practice Address - Country:US
Practice Address - Phone:620-724-8291
Practice Address - Fax:620-724-6332
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSTMP139428363LF0000X
KS75031363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSTMP139428OtherTEMPORARY LICENSE