Provider Demographics
NPI:1285012179
Name:CARRILLO, BETSY JEAN BOEHNER (APRN)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:JEAN BOEHNER
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9708 W 49TH PL
Mailing Address - Street 2:
Mailing Address - City:MERRIAM
Mailing Address - State:KS
Mailing Address - Zip Code:66203-4802
Mailing Address - Country:US
Mailing Address - Phone:913-909-6327
Mailing Address - Fax:
Practice Address - Street 1:7501 METCALF AVE
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-2927
Practice Address - Country:US
Practice Address - Phone:913-642-6330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-76523-021363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily