Provider Demographics
NPI:1861624843
Name:STEPANEK, NANCY FLAVIN (ANP-BC)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:FLAVIN
Last Name:STEPANEK
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7527 STATE AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-2815
Mailing Address - Country:US
Mailing Address - Phone:913-335-6986
Mailing Address - Fax:855-446-7151
Practice Address - Street 1:7527 STATE AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-2815
Practice Address - Country:US
Practice Address - Phone:913-335-6986
Practice Address - Fax:855-446-7151
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH-122972363LA2200X
MO2019009370363LA2200X, 363LP0808X
KS53-46290-122363LP0808X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO424246908Medicaid
KS201226410AMedicaid