Provider Demographics
NPI:1972042927
Name:HADLEY, TEIAH (NP-C)
Entity Type:Individual
Prefix:
First Name:TEIAH
Middle Name:
Last Name:HADLEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:TEIAH
Other - Middle Name:B
Other - Last Name:HADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1101 N ROCK RD
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-3705
Mailing Address - Country:US
Mailing Address - Phone:316-788-6963
Mailing Address - Fax:316-788-5373
Practice Address - Street 1:1101 N ROCK RD
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-3705
Practice Address - Country:US
Practice Address - Phone:316-788-6963
Practice Address - Fax:316-788-5373
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-77488-102363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSIN PROGRESSMedicaid
KSIN PROGRESSMedicaid