Active NPI
Andrea Stafos, ANP-BC
- Nurse Practitioner
- Overland Park, KS
National Provider Identifier
1700154374
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 75590
- Practice address
- 11791 W 112TH St
Suite 100
Overland Park, KS 66210-2737 - Phone
- (913) 888-3338
- Fax
- (913) 696-1908
- NPI assigned
- Dec 9, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 75590 | KS | Primary |
| Nurse Practitioner | 363L00000X | 2012036926 | MO |
Addresses
Primary practice location
11791 W 112TH St
Suite 100
Overland Park, KS 66210-2737
Mailing address
11791 W 112TH St
Suite 100
Overland Park, KS 66210-2737
Phone (913) 888-3338
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 068002152 | Other | KS | MEDICARE PTAN |
| P01157148 | Other | MO | RAILROAD MEDICARE |
| 200850160A | Medicaid | KS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 75590 | KS | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1323388800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1368144000000",
"number": "1700154374",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11791 W 112TH ST",
"address_2": "SUITE 100",
"city": "OVERLAND PARK",
"state": "KS",
"postal_code": "662102737",
"telephone_number": "913-888-3338",
"fax_number": "913-696-1908"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11791 W 112TH ST",
"address_2": "SUITE 100",
"city": "OVERLAND PARK",
"state": "KS",
"postal_code": "662102737",
"telephone_number": "913-888-3338",
"fax_number": "913-696-1908"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STAFOS",
"first_name": "ANDREA",
"credential": "ANP-BC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-12-09",
"last_updated": "2013-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "KS",
"license": "75590",
"primary": true
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MO",
"license": "2012036926",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "068002152",
"state": "KS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P01157148",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200850160A",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Overland Park, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.