Provider Demographics
NPI:1154348845
Name:STEPHENSON, JERI D (PAC)
Entity type:Individual
Prefix:
First Name:JERI
Middle Name:D
Last Name:STEPHENSON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 PROGRESS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:KS
Mailing Address - Zip Code:66043-6323
Mailing Address - Country:US
Mailing Address - Phone:913-651-3111
Mailing Address - Fax:913-651-3103
Practice Address - Street 1:1004 PROGRESS DR STE 200
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:KS
Practice Address - Zip Code:66043-6323
Practice Address - Country:US
Practice Address - Phone:913-651-3111
Practice Address - Fax:913-651-3103
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1500590363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant