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Individual

MICHELLE J STAHLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
3311 E MURDOCK ST, WICHITA, KS 67208-3054
(316) 689-9107
(316) 689-9354
Mailing address
PO BOX 8035, WICHITA, KS 67208-0035
(316) 689-9135

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1239
NE
363A00000X
Physician Assistant
Primary
15-01791
KS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1826
STATE LICENSE
NE
01
283821A
RURL HEALTH
01
P00338774
MEDICARE RAILROAD
Enumeration date
08/01/2006
Last updated
08/10/2015
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