Healthcare Provider Details

I. General information

NPI: 1316752868
Provider Name (Legal Business Name): KALLOS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E 3RD ST
FORT SCOTT KS
66701-2005
US

IV. Provider business mailing address

205 E 3RD ST
FORT SCOTT KS
66701-2005
US

V. Phone/Fax

Practice location:
  • Phone: 620-215-9005
  • Fax:
Mailing address:
  • Phone: 620-215-9005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KAYLA M. STEWART
Title or Position: APRN, OWNER
Credential: APRN
Phone: 620-215-9005