Provider Demographics
NPI:1053888206
Name:STUCKY, PAYTON FAY (APRN)
Entity type:Individual
Prefix:
First Name:PAYTON
Middle Name:FAY
Last Name:STUCKY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:PAYTON
Other - Middle Name:FAY
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 MEDICAL CENTER DR STE 210
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-4446
Mailing Address - Country:US
Mailing Address - Phone:316-283-2800
Mailing Address - Fax:316-283-3575
Practice Address - Street 1:700 MEDICAL CENTER DR STE 210
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-4446
Practice Address - Country:US
Practice Address - Phone:316-283-2800
Practice Address - Fax:316-283-3575
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-78436363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner