Provider Demographics
NPI:1831595545
Name:HALLERON, KAYLA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:
Last Name:HALLERON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 S MAPLE ST STE 400
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-1757
Mailing Address - Country:US
Mailing Address - Phone:952-856-4067
Mailing Address - Fax:952-442-8016
Practice Address - Street 1:8401 GOLDEN VALLEY RD STE 340
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4488
Practice Address - Country:US
Practice Address - Phone:952-960-9399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN14306363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical