Basic Information
| Provider Information | |||||||||
| NPI: | 1124410659 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KENDALL | ||||||||
| FirstName: | HALEY | ||||||||
| MiddleName: | JO | ||||||||
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| Credential: | APRN, FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 405 S CLAIRBORNE RD STE 2 | ||||||||
| Address2: | |||||||||
| City: | OLATHE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660621774 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136482266 | ||||||||
| FaxNumber: | 8553488430 | ||||||||
| Practice Location | |||||||||
| Address1: | 407 S CLAIRBORNE RD STE 104 | ||||||||
| Address2: | |||||||||
| City: | OLATHE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136482266 | ||||||||
| FaxNumber: | 8553488430 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2015 | ||||||||
| LastUpdateDate: | 01/14/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 2015000385 | MO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 76769 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1124410659 | 05 | MO | MEDICAID | 51646025 | 01 | KS | BLUE KC | OTHER | 7846973 | 01 | KS | AETNA | OTHER | 201216200A | 05 | KS | MEDICAID |