Provider Demographics
NPI:1316502602
Name:SUKUP, STEPHANIE (AGCNS-BC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:SUKUP
Suffix:
Gender:F
Credentials:AGCNS-BC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2750 CLAY EDWARDS DR STE 410
Mailing Address - Street 2:
Mailing Address - City:NORTH KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3258
Mailing Address - Country:US
Mailing Address - Phone:816-471-8114
Mailing Address - Fax:816-842-5342
Practice Address - Street 1:2750 CLAY EDWARDS DR STE 410
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3258
Practice Address - Country:US
Practice Address - Phone:816-471-8114
Practice Address - Fax:816-842-5342
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MO2019019628364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program