Healthcare Provider Details

I. General information

NPI: 1316482185
Provider Name (Legal Business Name): CANDRA MANLEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2017
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8748 W 151ST ST
OVERLAND PARK KS
66221-8705
US

IV. Provider business mailing address

8748 W 151ST ST
OVERLAND PARK KS
66221-8705
US

V. Phone/Fax

Practice location:
  • Phone: 913-386-3800
  • Fax: 913-386-3805
Mailing address:
  • Phone: 913-386-3800
  • Fax: 913-386-3805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2016039169
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number53-77642-101
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: