Provider Demographics
NPI:1609275502
Name:CORUM, STACY (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:CORUM
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:BLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15448 W 90TH ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-1102
Mailing Address - Country:US
Mailing Address - Phone:913-980-3351
Mailing Address - Fax:
Practice Address - Street 1:7440 W FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66203
Practice Address - Country:US
Practice Address - Phone:913-236-6455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-15
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS76436363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health