Provider Demographics
NPI:1780417907
Name:SMALLEY, KACI (APRN)
Entity type:Individual
Prefix:
First Name:KACI
Middle Name:
Last Name:SMALLEY
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 1:2 KNOTT CT
Mailing Address - Street 2:
Mailing Address - City:HESSTON
Mailing Address - State:KS
Mailing Address - Zip Code:67062-9019
Mailing Address - Country:US
Mailing Address - Phone:316-518-5991
Mailing Address - Fax:
Practice Address - Street 1:1541 N LINDBERG CIR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-6400
Practice Address - Country:US
Practice Address - Phone:316-358-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5383521102363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner