Provider Demographics
NPI:1740603307
Name:BALLEW, KARLA CHANEY (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:KARLA
Middle Name:CHANEY
Last Name:BALLEW
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KARLA
Other - Middle Name:SILVESTRE
Other - Last Name:CHANEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4686 POINTES DR STE 219
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-6038
Mailing Address - Country:US
Mailing Address - Phone:425-405-8089
Mailing Address - Fax:425-426-2277
Practice Address - Street 1:4686 POINTES DR STE 219
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-6038
Practice Address - Country:US
Practice Address - Phone:425-405-8089
Practice Address - Fax:425-426-2277
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-31
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60446757363LA2200X, 363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8934378Medicare UPIN