Healthcare Provider Details

I. General information

NPI: 1679401335
Provider Name (Legal Business Name): CARLY ESPARZA-HOLM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3310 CLINTON PARKWAY CT
LAWRENCE KS
66047-2629
US

IV. Provider business mailing address

3310 CLINTON PARKWAY CT
LAWRENCE KS
66047-2629
US

V. Phone/Fax

Practice location:
  • Phone: 785-856-9090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number53-85591-072
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: