Provider Demographics
NPI:1598420739
Name:WALLEN, KARLA SUE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:KARLA
Middle Name:SUE
Last Name:WALLEN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 800022
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-0022
Mailing Address - Country:US
Mailing Address - Phone:800-953-0104
Mailing Address - Fax:303-765-6670
Practice Address - Street 1:2101 KEN PRATT BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6568
Practice Address - Country:US
Practice Address - Phone:303-649-3500
Practice Address - Fax:303-649-3501
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COAPN.0997083-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily