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General NPI Number Information
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NPI Number | 1548189624
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Entity Type | Individual
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Provider Name | KAYLEE BOELTER
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Gender | Female
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Dates
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Enumeration Date | 07/13/2026
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Last Update Date | 07/13/2026
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Provider Practice Location Address
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Address Line | 12107 STRATFORD DR
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City | CLIVE
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State | IA
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Zip | 50325-8146
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Country | US
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Telephone | 515-395-7661
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Fax |
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Provider Business Mailing Address
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Address Line | 1025 68TH ST UNIT 8
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City | WEST DES MOINES
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State | IA
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Zip | 50266-5709
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Country | US
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Telephone | 507-951-9589
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Fax |
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AG06260172
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License Number State | IA
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