Healthcare Provider Details

I. General information

NPI: 1053840595
Provider Name (Legal Business Name): KALLA CARLTON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KALLA KLINE

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1863 EAST FLORENCE BLVD
CASA GRANDE AZ
85122
US

IV. Provider business mailing address

PO BOX 96395
PHOENIX AZ
85072-6395
US

V. Phone/Fax

Practice location:
  • Phone: 520-836-3446
  • Fax: 520-350-7557
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: