MEDICARE: BETSY JEAN BOEHNER CARRILLO APRN

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	53-76523-021	KS

General Provider Information

NPI Number	:	1285012179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETSY JEAN BOEHNER CARRILLO APRN

Provider Business Mailing Address
First Line	:	9708 W 49TH PL
Second Line	:
City	:	MERRIAM
State	:	KS
Zip	:	66203-4802
Country	:	US
Telephone Number	:	913-909-6327
Fax Number	:

Provider Business Practice Location Address
First Line	:	7501 METCALF AVE
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66204-2927
Country	:	US
Telephone Number	:	913-642-6330
Fax Number	:

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

Provider Enumeration Date	:	05/11/2015
Last Update Date	:	05/11/2015

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