Provider Demographics
NPI:1497929483
Name:NICKS, STEPHANIE R (MSN, ARNP, FNP)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:R
Last Name:NICKS
Suffix:
Gender:F
Credentials:MSN, ARNP, FNP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:R
Other - Last Name:KNITIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:2020 N TYLER RD
Mailing Address - Street 2:STE 112
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-4905
Mailing Address - Country:US
Mailing Address - Phone:316-312-0002
Mailing Address - Fax:316-854-5644
Practice Address - Street 1:2020 N TYLER RD
Practice Address - Street 2:STE 112
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-4905
Practice Address - Country:US
Practice Address - Phone:316-312-0002
Practice Address - Fax:316-854-5644
Is Sole Proprietor?:No
Enumeration Date:2008-04-21
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS46074363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1497929483OtherNPI