DR. STACY L PETERSON (NPI# 1316030638) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1316030638 |
Entity Type | Individual |
Full Name | DR. STACY L PETERSON |
Credential | M.D. |
Practice Address |
818 N Emporia St Suite 305 Wichita KS 67214-3729 |
Practice Telephone | 3162651441 |
Practice Fax Number | 3162651685 |
Mailing Telephone | 3162651441 |
Mailing Fax Number | 3162651685 |
Enumeration Date | 2006-09-30 |
Last Update Date | 2007-07-08 |
Gender Code | M |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 2086S0122X |
Surgery Specialization: Plastic and Reconstructive Surgery |
0419242 | KS | Allopathic & Osteopathic Physicians |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1992259519 | Stacy Peterson | Counselor | 2 5th St N Ste 202, Great Falls, MT 59401-4011 | 2016-08-11 |
1518234913 | Stacy Elizabeth Peterson | Speech-Language Pathologist | 1004 Inwood Dr, Hurst, TX 76053-4129 | 2011-11-29 |
1922522838 | Stacy Peterson | Social Worker | 9409 N Haggerty Rd, Plymouth, MI 48170-4696 | 2017-08-01 |
1730627571 | Stacy Peterson | Behavior Technician | 355 Citrus Tower Blvd, Suite 116, Clermont, FL 34711-6501 | 2017-02-01 |
1295167922 | Stacy Lashunn Peterson | Counselor | 501 W Columbus St, Bakersfield, CA 93301 | 2013-08-05 |
1821314774 | Stacy M. Peterson | Social Worker | 405 Clement St, Suite #2, San Francisco, CA 94118-2317 | 2010-04-18 |
1942460563 | Stacy Peterson | Developmental Therapist | 8615 Crawford Ave, Skokie, IL 60076-2125 | 2008-06-17 |
1356515704 | Stacy Peterson | Anesthesiology | 9000 W Wisconsin Ave, Milwaukee, WI 53226-4874 | 2008-04-16 |
1952416489 | Stacy Peterson | Emergency Medicine | 1997 Miamisburg Centerville Rd, Dayton, OH 45459-3811 | 2006-08-21 |
Street Address |
818 N EMPORIA ST SUITE 305 |
City | WICHITA |
State | KS |
Zip Code | 67214-3729 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1033116835 | Duane L Osborne | Surgery | 818 N Emporia St, Suite 200, Wichita, KS 67214-3729 | 2005-07-07 |
1053727800 | Tracy D Smith | Nurse Practitioner | 818 N Emporia St, Suite 310, Wichita, KS 67214-3729 | 2014-07-01 |
1336401082 | Aaron Nilhas | Surgery | 818 N Emporia St, Suite 200, Wichita, KS 67214-3729 | 2012-06-08 |
1205164282 | Bernard T. Poole, Md, Pa | Orthopaedic Surgery | 818 N Emporia St, Suite 107, Wichita, KS 67214-3729 | 2009-12-02 |
1679704845 | Julianna M Bergkamp | Nurse Practitioner | 818 N Emporia St, Suite 403, Wichita, KS 67214-3729 | 2009-08-05 |
1609004316 | Amanda M Valliant | Internal Medicine | 818 N Emporia St, Suite 310, Wichita, KS 67214-3729 | 2009-07-01 |
1730320367 | Kathy Ornelas | Specialist/Technologist, Other | 818 N Emporia St, Suite 200, Wichita, KS 67214-3729 | 2009-03-11 |
1437316387 | Ronnie K Moussa | Internal Medicine | 818 N Emporia St, Suite 310, Wichita, KS 67214-3729 | 2008-05-19 |
1104025949 | Wissam Saliba | Internal Medicine | 818 N Emporia St, Wichita, KS 67214-3729 | 2007-07-12 |
1528263043 | Jeremy Deutsch | Internal Medicine | 818 N Emporia St, Suite 403, Wichita, KS 67214-3729 | 2007-06-15 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1124591185 | Laquita Patrice Boyede | Durable Medical Equipment & Medical Supplies | 1503 Northeast Parkway, Wichita, KS 67214 | 2019-01-02 |
1891270674 | Kathryn Denise Boomer | Physician Assistant | 929 St. Francis N, Wichita, KS 67214 | 2018-09-27 |
1447756457 | Cardinal Health 132 LLC | Pharmacy | 527 N Grove Street, Suite 100, Wichita, KS 67214 | 2018-03-30 |
1023517174 | Laboratory Corporation of America Holdings | Clinical Medical Laboratory | 3243 E Murdock Street, Level G, Wichita, KS 67214 | 2018-02-05 |
1558887901 | Shonnetta Lachan Gabriel | Counselor | 2707 E. 21st St. N, Wichita, KS 67214 | 2017-08-17 |
1417492174 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 803 N Broadway Ave, Wichita, KS 67214 | 2017-01-04 |
1952850653 | Rachel J Johnson | Counselor | 805 N Volutsia, Wichita, KS 67214 | 2016-09-23 |
1063899813 | Christy Lee Foos | Social Worker | 2707 E. 21st St. North, Healthcore Clinic, Wichita, KS 67214 | 2015-04-30 |
1952708018 | William Schroeder Fargo | Specialist | 701 N. Emporia, Wichita, KS 67214 | 2014-12-04 |
1447692710 | Valeriya V Hunter | Dentist | 527 N Grove, Wichita, KS 67214 | 2013-07-26 |
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Taxonomy Code | 2086S0122X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Surgery |
Specialization | Plastic and Reconstructive Surgery |
A surgeon who specializes in plastic and reconstructive surgery. |
Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate is issued by the American Osteopathic Board of Surgery. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1598724031 | Nicky R Wheeler | Surgery | 1700 Waterfront Parkway, Bldg 200, Wichita, KS 67206 | 2006-03-22 |
1760478713 | Joseph T Poggi | Surgery | 3510 N. Ridge Road, Suite 100, Wichita, KS 67205-1210 | 2005-09-26 |
1528225166 | Mitchell Flurry | Surgery | 1947 N Founders Cir, Wichita, KS 67206-3548 | 2008-05-21 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1396802898 | Eric Swanson | Surgery | 11413 Ash, Leawood, KS 66211 | 2007-01-03 |
1235184888 | Plastic Surgery, P.a. | Surgery | 4701 College Blvd, Suite 206, Leawood, KS 66211-1603 | 2006-05-23 |
1598748055 | Mona A Rane | Surgery | 109 E. 11th Street, Liberal, KS 67901-2762 | 2005-11-29 |
1609436815 | Kalila Anne Steen | Surgery | 4801 W 135th St, Leawood, KS 66224-8901 | 2019-06-19 |
1891247326 | Lawrence Physicians LLC | Surgery | 1130 W 4th St, Suite 3200, Lawrence, KS 66044-1328 | 2016-11-01 |
1538403175 | Singhal Plastic Surgery Pa | Surgery | 5250 W 94th Ter, Prairie Village, KS 66207-2502 | 2012-11-20 |
1750642450 | Heather Lorita Pena | Surgery | 823 Sw Mulvane St, Ste 200, Topeka, KS 66606-1764 | 2012-05-30 |
1043570823 | Elizabeth Anne Killion | Surgery | 4801 W 135th St, Leawood, KS 66224 | 2012-05-25 |
1578839940 | Anita Scarlett Aldrich | Surgery | 1130 W 4th St Ste 3202, Lawrence, KS 66044 | 2012-03-29 |
1457689770 | Center for Plastic Surgery, Pa | Surgery | 631 Sw Horne St, Suite 400, Topeka, KS 66606-1694 | 2009-11-24 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.