Provider Demographics
NPI:1255621744
Name:STALEY, ANDREA FELICE
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:FELICE
Last Name:STALEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 S KENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-2908
Mailing Address - Country:US
Mailing Address - Phone:913-390-6249
Mailing Address - Fax:
Practice Address - Street 1:2102 S KENWOOD ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-2908
Practice Address - Country:US
Practice Address - Phone:913-390-6249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator