Provider Demographics
NPI:1013923457
Name:STUART, MARY BETH (RPA-C)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:STUART
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:BETH
Other - Last Name:LEAHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA-C
Mailing Address - Street 1:15319 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-1262
Mailing Address - Country:US
Mailing Address - Phone:913-495-9905
Mailing Address - Fax:
Practice Address - Street 1:15319 W 95TH ST
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66219-1262
Practice Address - Country:US
Practice Address - Phone:913-495-9905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007373363A00000X
KS15-01673363A00000X
MO2014005142363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02730032Medicaid
NY6012L1Medicare ID - Type Unspecified
NY02730032Medicaid