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General NPI Number Information
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NPI Number | 1831595545
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Entity Type | Individual
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Provider Name | KAYLA HALLERON PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/06/2014
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 8401 GOLDEN VALLEY RD STE 340
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City | GOLDEN VALLEY
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State | MN
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Zip | 55427-4488
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Country | US
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Telephone | 952-960-9399
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Fax |
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Provider Business Mailing Address
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Address Line | 560 S MAPLE ST STE 400
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City | WACONIA
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State | MN
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Zip | 55387-1757
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Country | US
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Telephone | 952-856-4067
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Fax | 952-442-8016
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 14306
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License Number State | MN
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