Individual
MR. TIMOTHY C STALLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
23401 PRAIRIE STAR PKWY, SUITE 300, LENEXA, KS 66227-7268
(913) 677-6319
(913) 677-1540
Mailing address
23401 PRAIRIE STAR PKWY STE B300, LENEXA, KS 66227-7268
(913) 677-6319
(913) 677-1540
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
1500547
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30004502040004
—
KS
Enumeration date
04/07/2006
Last updated
03/24/2025
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