Provider Demographics
NPI:1922070101
Name:STUCKER, ROBERT TROY (PA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:TROY
Last Name:STUCKER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:TROY
Other - Middle Name:
Other - Last Name:STUCKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:10701 NALL AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1231
Mailing Address - Country:US
Mailing Address - Phone:913-381-5225
Mailing Address - Fax:913-901-0186
Practice Address - Street 1:10701 NALL AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1231
Practice Address - Country:US
Practice Address - Phone:913-381-5225
Practice Address - Fax:913-901-0186
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1501122363AS0400X
MO2006001741363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00401009OtherMEDICARE-RR
KSP00416360OtherMEDICARE-RR
KSP00416360OtherMEDICARE-RR
KS115E509AMedicare PIN
MOP00401009OtherMEDICARE-RR
KS0447460003Medicare NSC