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Individual

ANDREA STAFOS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ANP-BC

Contact information

Practice address
11791 W 112TH ST, SUITE 100, OVERLAND PARK, KS 66210-2737
(913) 888-3338
(913) 696-1908
Mailing address
11791 W 112TH ST, SUITE 100, OVERLAND PARK, KS 66210-2737
(913) 888-3338
(913) 696-1908

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
2012036926
MO
363L00000X
Nurse Practitioner
Primary
75590
KS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
068002152
MEDICARE PTAN
KS
05
200850160A
KS
01
P01157148
RAILROAD MEDICARE
MO
Enumeration date
12/09/2011
Last updated
05/10/2013
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