Provider Demographics
NPI:1336509082
Name:STAKLEY, SARAH (AGNP)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:STAKLEY
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:RIEKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10550 MARTY ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-2557
Mailing Address - Country:US
Mailing Address - Phone:913-341-4000
Mailing Address - Fax:
Practice Address - Street 1:10500 QUIVIRA RD
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-2306
Practice Address - Country:US
Practice Address - Phone:913-341-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS363L00000X363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner