Provider Demographics
NPI:1265879258
Name:BALLWEG, KAYLA ANN (APRN, NP-C)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:ANN
Last Name:BALLWEG
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:ANN
Other - Last Name:COSTELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7100 W 151ST ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-2232
Mailing Address - Country:US
Mailing Address - Phone:913-850-9048
Mailing Address - Fax:
Practice Address - Street 1:7100 W 151ST ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-2232
Practice Address - Country:US
Practice Address - Phone:913-681-3950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-75882-122363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily