Provider Demographics
NPI:1396085395
Name:STAMBACH, MISTY (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:
Last Name:STAMBACH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4321 WASHINGTON ST STE 3000
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-5928
Mailing Address - Country:US
Mailing Address - Phone:816-932-3100
Mailing Address - Fax:816-932-6871
Practice Address - Street 1:4321 WASHINGTON ST STE 3000
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5928
Practice Address - Country:US
Practice Address - Phone:816-932-3100
Practice Address - Fax:816-932-6871
Is Sole Proprietor?:No
Enumeration Date:2013-02-27
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013005694363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P1509093OtherRAILROAD MEDICARE
P1509093OtherRAILROAD MEDICARE