Provider Demographics
NPI:1427629211
Name:BALTZ, KAYLEY
Entity type:Individual
Prefix:
First Name:KAYLEY
Middle Name:
Last Name:BALTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10355 DOVER ST APT 1321
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-3979
Mailing Address - Country:US
Mailing Address - Phone:870-378-6325
Mailing Address - Fax:
Practice Address - Street 1:10355 DOVER ST APT 1321
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-3979
Practice Address - Country:US
Practice Address - Phone:870-378-6325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-APN.0003047-C-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily