Provider Demographics
NPI:1316300528
Name:STEPHENS, JAMES M II (ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:M
Last Name:STEPHENS
Suffix:II
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5448 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:ROELAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66205-1169
Mailing Address - Country:US
Mailing Address - Phone:580-585-0377
Mailing Address - Fax:
Practice Address - Street 1:5960 DEARBORN ST
Practice Address - Street 2:SUITE 10
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-3342
Practice Address - Country:US
Practice Address - Phone:913-236-0066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-007542255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer