Healthcare Provider Details

I. General information

NPI: 1063222818
Provider Name (Legal Business Name): KENDALL STALEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 09/20/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11340 NALL AVE
OVERLAND PARK KS
66211-1234
US

IV. Provider business mailing address

9803 WESTMINSTER CT
LENEXA KS
66215-1416
US

V. Phone/Fax

Practice location:
  • Phone: 816-525-2840
  • Fax:
Mailing address:
  • Phone: 913-800-0861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number24-01915
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2026033640
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: