Kyla S Balzar, NP
Individual provider Active NPI Family Nurse Practitioner · Green Bay, WI
NPI 1487316006 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1487316006
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 11385-33 (WI)
- Practice address
- 2020 S Webster Ave
Green Bay, WI 54301-2291 - Phone
- (920) 445-7210
- NPI assigned
- Oct 11, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 13
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Bellin Memorial Hospital Inc
Practice addresses (Care Compare)
1630 Commanche Ave
Green Bay, WI 54313-5753
Phone (920) 430-4700
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211110002215 | WI | Practitioner - Nurse Practitioner | 7618366782 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11385-33 | WI | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bellin Memorial Hospital Inc | Current |
Accepting new patients | |
| Oconto Hospital & Medical Center Inc | Current |
Accepting new patients | |
| Bellin Memorial Hospital Inc | Current |
Accepting new patients | |
| Bellin Memorial Hospital Inc | Current | Accepting new patients | |
| Oconto Hospital & Medical Center Inc | Current |
Accepting new patients |
Locations
704 S Webster Ave
Ste 201
Green Bay, WI 54301
Phone (920) 433-3410
744 S Webster Ave
Green Bay, WI 54301
Phone (920) 433-6025
1630 Commanche Ave
Green Bay, WI 54313
Phone (920) 430-4700
3263 Eaton Rd
Green Bay, WI 54311
Phone (920) 433-6000
2020 S Webster Ave
Green Bay, WI 54301
Phone (920) 445-7288
2820 Roosevelt Rd
Marinette, WI 54143
Phone (715) 330-6171
820 Arbutus Ave
Oconto, WI 54153
Phone (920) 835-1100
Interoperability endpoints
- kbalzar946282@direct.emplifyhealth.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 11385-33 | WI | Yes |
Addresses
Primary practice location
2020 S Webster Ave
Green Bay, WI 54301-2291
Mailing address
PO Box 22487
Green Bay, WI 54305-2487
Phone (920) 445-7222
Other practice location 1
1630 Commanche Ave
Green Bay, WI 54313-5753
Phone (920) 430-4700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2021033573 | Other | AMERICAN NURSES CREDENTIALING CENTER |
Other names
- Kyla S Gerke
Other providers in Green Bay, WI
- Bela R. Ballo
- Frances Stahl Ballo
- Jennifer Lynn Balthazor
- Al Baltrusaitis
- James Joseph Balza
- Denise M Balzola
- Stephanie Banaszynski
- Lauren Louise Bancroft
- Pradeep Bangalore Prakash
- Dovile Baniulis
All providers in Green Bay, WI · Family Nurse Practitioner in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.