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NPI Code Detail

MEDICARE: KAYLEE WALLER CRNA

MEDICARE: KAYLEE WALLER CRNA
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
1367500000XCertified Registered Nurse Anesthetist100315TX
2367500000XCertified Registered Nurse Anesthetist742739NC
3367500000XCertified Registered Nurse Anesthetist742739TX

General Provider Information

NPI Number : 1356762728
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAYLEE WALLER CRNA
Provider Business Mailing Address
First Line : 14850 QUORUM DR STE 400
Second Line :
City : DALLAS
State : TX
Zip : 75254-1445
Country : US
Telephone Number : 469-437-3564
Fax Number : 469-825-6903
Provider Business Practice Location Address
First Line : 14850 QUORUM DR STE 400
Second Line :
City : DALLAS
State : TX
Zip : 75254-1445
Country : US
Telephone Number : 469-437-3564
Fax Number : 469-825-6903
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2014
Last Update Date : 10/10/2024

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Directions to “ KAYLEE WALLER CRNA” Practice Location

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