Provider Demographics
NPI:1124410659
Name:KENDALL, HALEY JO (APRN, FNP)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:JO
Last Name:KENDALL
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 S CLAIRBORNE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1774
Mailing Address - Country:US
Mailing Address - Phone:913-648-2266
Mailing Address - Fax:855-348-8430
Practice Address - Street 1:407 S CLAIRBORNE RD STE 104
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062
Practice Address - Country:US
Practice Address - Phone:913-648-2266
Practice Address - Fax:855-348-8430
Is Sole Proprietor?:No
Enumeration Date:2015-02-20
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015000385363LF0000X
KS76769363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1124410659Medicaid
KS51646025OtherBLUE KC
KS7846973OtherAETNA
KS201216200AMedicaid