Provider Demographics
NPI:1336510312
Name:KALE, STACEY (APRN)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:
Last Name:KALE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 EAST ST
Mailing Address - Street 2:
Mailing Address - City:IOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66749-4402
Mailing Address - Country:US
Mailing Address - Phone:620-365-3115
Mailing Address - Fax:620-365-7717
Practice Address - Street 1:1408 EAST ST
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:KS
Practice Address - Zip Code:66749-4402
Practice Address - Country:US
Practice Address - Phone:620-365-3115
Practice Address - Fax:620-365-7717
Is Sole Proprietor?:No
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-76889-072363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily