Provider Demographics
NPI:1922105238
Name:BERKSTRESSER, STEPHEN R (PA-C)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:R
Last Name:BERKSTRESSER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 YANDELL COVE RD
Mailing Address - Street 2:
Mailing Address - City:KIRBYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65679-8387
Mailing Address - Country:US
Mailing Address - Phone:417-546-5572
Mailing Address - Fax:
Practice Address - Street 1:343 YANDELL COVE RD
Practice Address - Street 2:
Practice Address - City:KIRBYVILLE
Practice Address - State:MO
Practice Address - Zip Code:65679-8387
Practice Address - Country:US
Practice Address - Phone:417-546-5572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO102310363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO220082007Medicaid
MO507954006Medicaid
8068OtherBCBS
080110697OtherRAILROAD MEDICARE