Provider Demographics
NPI:1558635508
Name:VANTREASE, KAYLEE L
Entity type:Individual
Prefix:MRS
First Name:KAYLEE
Middle Name:L
Last Name:VANTREASE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KAYLEE
Other - Middle Name:L
Other - Last Name:EHLERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3810 KERN WAY STE B
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-7805
Mailing Address - Country:US
Mailing Address - Phone:509-228-7237
Mailing Address - Fax:844-315-7388
Practice Address - Street 1:3810 KERN WAY STE B
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902
Practice Address - Country:US
Practice Address - Phone:509-228-7237
Practice Address - Fax:844-315-7388
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60971567363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2134845Medicaid