Provider Demographics
NPI:1033890405
Name:STEPHENSON, SUMMER GRACE
Entity type:Individual
Prefix:
First Name:SUMMER
Middle Name:GRACE
Last Name:STEPHENSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 W 175TH ST S
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:KS
Mailing Address - Zip Code:67022-8301
Mailing Address - Country:US
Mailing Address - Phone:620-845-2516
Mailing Address - Fax:620-845-2518
Practice Address - Street 1:761 W 175TH ST S
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:KS
Practice Address - Zip Code:67022-8301
Practice Address - Country:US
Practice Address - Phone:620-845-2516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-28
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant