Provider Demographics
NPI:1609845338
Name:STUCKY, RACHEL A (MD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:A
Last Name:STUCKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6837 W 37TH ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-9355
Mailing Address - Country:US
Mailing Address - Phone:316-773-3100
Mailing Address - Fax:316-773-3777
Practice Address - Street 1:6837 W 37TH ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-9355
Practice Address - Country:US
Practice Address - Phone:316-773-3100
Practice Address - Fax:316-773-3777
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-33448208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR157693001Medicaid
AR5-N271Medicare ID - Type Unspecified
AR157693001Medicaid