Healthcare Provider Details

I. General information

NPI: 1114788361
Provider Name (Legal Business Name): HAILEY KELLY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2024
Last Update Date: 01/19/2026
Certification Date: 01/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2902 SW ASBURY DR
TOPEKA KS
66614-4466
US

IV. Provider business mailing address

2902 SW ASBURY DR
TOPEKA KS
66614-4466
US

V. Phone/Fax

Practice location:
  • Phone: 785-354-9591
  • Fax:
Mailing address:
  • Phone: 785-354-9591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number53-82923
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number144340
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: