Provider Demographics
NPI:1033706619
Name:HULSE, STEPHANIE RAYCHAEL (NP-FNP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RAYCHAEL
Last Name:HULSE
Suffix:
Gender:F
Credentials:NP-FNP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:RAYCHAEL
Other - Last Name:NOLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9119 W 74TH ST STE 350
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2268
Mailing Address - Country:US
Mailing Address - Phone:913-632-9400
Mailing Address - Fax:913-632-9444
Practice Address - Street 1:9119 W 74TH ST STE 350
Practice Address - Street 2:
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-2268
Practice Address - Country:US
Practice Address - Phone:913-632-9400
Practice Address - Fax:913-632-9444
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020042549363LF0000X
KS53-81061363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420092300Medicaid