Provider Demographics
NPI:1457772857
Name:STOVER, GEVAN
Entity Type:Individual
Prefix:
First Name:GEVAN
Middle Name:
Last Name:STOVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S WEST ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67213-2113
Mailing Address - Country:US
Mailing Address - Phone:316-440-3750
Mailing Address - Fax:316-440-3755
Practice Address - Street 1:125 S WEST ST
Practice Address - Street 2:SUITE 101
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213-2113
Practice Address - Country:US
Practice Address - Phone:316-440-3750
Practice Address - Fax:316-440-3755
Is Sole Proprietor?:No
Enumeration Date:2014-01-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1563237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist