Provider Demographics
NPI:1801996897
Name:FORD, STACY (WHNP)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:FORD
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7440 FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66203-4670
Mailing Address - Country:US
Mailing Address - Phone:913-236-6455
Mailing Address - Fax:913-236-1111
Practice Address - Street 1:7440 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:MERRIAM
Practice Address - State:KS
Practice Address - Zip Code:66203-4670
Practice Address - Country:US
Practice Address - Phone:913-236-6455
Practice Address - Fax:913-236-1111
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45216363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS606D211Medicare PIN