Provider Demographics
NPI:1932105426
Name:STEGEMAN, KATHLEEN A (ARNP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:STEGEMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 W 58TH ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-1999
Mailing Address - Country:US
Mailing Address - Phone:913-676-6120
Mailing Address - Fax:913-432-8463
Practice Address - Street 1:5555 W 58TH ST
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-1999
Practice Address - Country:US
Practice Address - Phone:913-676-6120
Practice Address - Fax:913-432-8463
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS74567363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSS83523Medicare UPIN
KSF200000Medicare PIN
KSF208654Medicare PIN