Provider Demographics
NPI:1588020002
Name:SHULL, STEPHANIE A (PA-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:SHULL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ANN
Other - Last Name:GOLUB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:10777 NALL AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1330
Mailing Address - Country:US
Mailing Address - Phone:913-642-0200
Mailing Address - Fax:913-563-6699
Practice Address - Street 1:10777 NALL AVE STE 300
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1330
Practice Address - Country:US
Practice Address - Phone:913-642-0200
Practice Address - Fax:913-563-6699
Is Sole Proprietor?:No
Enumeration Date:2016-01-13
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016000760363AS0400X
KS15-01867363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical