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General NPI Number Information
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NPI Number | 1356762728
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Entity Type | Individual
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Provider Name | KAYLEE WALLER CRNA
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Gender | Female
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Dates
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Enumeration Date | 01/02/2014
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 14850 QUORUM DR STE 400
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City | DALLAS
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State | TX
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Zip | 75254-1445
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Country | US
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Telephone | 469-437-3564
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Fax | 469-825-6903
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Provider Business Mailing Address
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Address Line | 14850 QUORUM DR STE 400
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City | DALLAS
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State | TX
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Zip | 75254-1445
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Country | US
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Telephone | 469-437-3564
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Fax | 469-825-6903
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 100315
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 742739
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 742739
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License Number State | TX
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