Healthcare Provider Details

I. General information

NPI: 1548189624
Provider Name (Legal Business Name): KAYLEE BOELTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12107 STRATFORD DR
CLIVE IA
50325-8146
US

IV. Provider business mailing address

1025 68TH ST UNIT 8
WEST DES MOINES IA
50266-5709
US

V. Phone/Fax

Practice location:
  • Phone: 515-395-7661
  • Fax:
Mailing address:
  • Phone: 507-951-9589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAG06260172
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: