Provider Demographics
NPI:1841841160
Name:STALEY, JO ANN
Entity type:Individual
Prefix:
First Name:JO
Middle Name:ANN
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 1:12477 S ELLSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-4970
Mailing Address - Country:US
Mailing Address - Phone:816-718-7077
Mailing Address - Fax:
Practice Address - Street 1:12477 S ELLSWORTH ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-4970
Practice Address - Country:US
Practice Address - Phone:816-718-7077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty