Provider Demographics
NPI:1851386932
Name:HAILEY, RACHEL L (MD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:L
Last Name:HAILEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 NE TUDOR RD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-5696
Mailing Address - Country:US
Mailing Address - Phone:816-524-8488
Mailing Address - Fax:816-524-8118
Practice Address - Street 1:270 NE TUDOR RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-5696
Practice Address - Country:US
Practice Address - Phone:816-524-8488
Practice Address - Fax:816-524-8118
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD 2000152522207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100453470BMedicaid
MO209104009Medicaid
MOH41761Medicare UPIN
MO209104009Medicaid