Provider Demographics
NPI:1457591372
Name:HALE, SUSAN (FNP-BC, PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:HALE
Suffix:
Gender:F
Credentials:FNP-BC, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17795 W 106TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-3155
Mailing Address - Country:US
Mailing Address - Phone:913-359-3880
Mailing Address - Fax:913-276-1339
Practice Address - Street 1:17795 W 106TH ST STE 200
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-3155
Practice Address - Country:US
Practice Address - Phone:913-359-3880
Practice Address - Fax:913-276-1339
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006025799363LF0000X
KS53-76859-032363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily