Provider Demographics
NPI:1326696006
Name:BALTARE, CARLY NOEL FRANCES KIBLER (PA)
Entity Type:Individual
Prefix:MRS
First Name:CARLY
Middle Name:NOEL FRANCES KIBLER
Last Name:BALTARE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:
Other - Last Name:KIBLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8006 E ARAPAHOE RD # 100
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-6814
Mailing Address - Country:US
Mailing Address - Phone:303-220-9168
Mailing Address - Fax:
Practice Address - Street 1:8006 E ARAPAHOE RD # 100
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-6814
Practice Address - Country:US
Practice Address - Phone:303-220-9168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
COPA.0006853363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program