MEDICARE: KAYLEY BALTZ

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	C-APN.0003047-C-NP	CO

General Provider Information

NPI Number	:	1427629211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLEY BALTZ

Provider Business Mailing Address
First Line	:	10355 DOVER ST APT 1321
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80021-3979
Country	:	US
Telephone Number	:	870-378-6325
Fax Number	:

Provider Business Practice Location Address
First Line	:	10355 DOVER ST APT 1321
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80021-3979
Country	:	US
Telephone Number	:	870-378-6325
Fax Number	:

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

Provider Enumeration Date	:	07/02/2021
Last Update Date	:	07/02/2021

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Directions to “ KAYLEY BALTZ ” Practice Location

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