Provider Demographics
NPI:1871106740
Name:METTS, STEVIE JONAE
Entity type:Individual
Prefix:
First Name:STEVIE
Middle Name:JONAE
Last Name:METTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 E DEL MAR ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67216-1535
Mailing Address - Country:US
Mailing Address - Phone:316-554-4214
Mailing Address - Fax:
Practice Address - Street 1:1207 E DEL MAR ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67216-1535
Practice Address - Country:US
Practice Address - Phone:316-554-4214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider