Provider Demographics
NPI:1962037770
Name:KIPKULEI, STANLEY (NP)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:
Last Name:KIPKULEI
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11805 TROOST AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-3774
Mailing Address - Country:US
Mailing Address - Phone:913-221-2625
Mailing Address - Fax:
Practice Address - Street 1:10870 BENSON DR STE 2160
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1509
Practice Address - Country:US
Practice Address - Phone:833-357-3227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-12
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019081674363LP0808X
KS5379195072363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty