Provider Demographics
NPI:1659557874
Name:ELLIOTT, STEPHANIE R (DO)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:R
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:2790 CLAY EDWARDS DR
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3276
Mailing Address - Country:US
Mailing Address - Phone:816-468-7800
Mailing Address - Fax:816-468-8531
Practice Address - Street 1:2790 CLAY EDWARDS DR
Practice Address - Street 2:SUITE 1200
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3276
Practice Address - Country:US
Practice Address - Phone:816-468-7800
Practice Address - Fax:816-468-8531
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2014-09-18
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Provider Licenses
StateLicense IDTaxonomies
MO2013029392207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
110403008Medicare PIN