Provider Demographics
NPI:1770311284
Name:STOCK, KASSIE COLLEEN (FNP)
Entity type:Individual
Prefix:
First Name:KASSIE
Middle Name:COLLEEN
Last Name:STOCK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4133 SE CORINTH CT
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:KS
Mailing Address - Zip Code:66542-2618
Mailing Address - Country:US
Mailing Address - Phone:785-713-2908
Mailing Address - Fax:
Practice Address - Street 1:2721 SE 10TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66607-1706
Practice Address - Country:US
Practice Address - Phone:785-783-8453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-83419-042363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily