MEDICARE: KAYLA ANN BALLWEG APRN, NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	53-75882-122	KS

General Provider Information

NPI Number	:	1265879258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA ANN BALLWEG APRN, NP-C

Provider Business Mailing Address
First Line	:	7100 W 151ST ST
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66223-2232
Country	:	US
Telephone Number	:	913-850-9048
Fax Number	:

Provider Business Practice Location Address
First Line	:	7100 W 151ST ST
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66223-2232
Country	:	US
Telephone Number	:	913-681-3950
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2013
Last Update Date	:	11/20/2017

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