Provider Demographics
NPI:1154031904
Name:RADKE-PENCE, STEPHANIE R (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:R
Last Name:RADKE-PENCE
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:EUDORA
Mailing Address - State:KS
Mailing Address - Zip Code:66025-9552
Mailing Address - Country:US
Mailing Address - Phone:785-550-0154
Mailing Address - Fax:
Practice Address - Street 1:907 E LINCOLN LN
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:KS
Practice Address - Zip Code:66030-3701
Practice Address - Country:US
Practice Address - Phone:913-856-1369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS81590363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS81590OtherSTATE LICENSE