Provider Demographics
NPI:1164245874
Name:BALKO, KAREN MAE VALERA
Entity type:Individual
Prefix:
First Name:KAREN MAE
Middle Name:VALERA
Last Name:BALKO
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 1:6771 SHARKS BAY CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-5193
Mailing Address - Country:US
Mailing Address - Phone:702-583-1593
Mailing Address - Fax:
Practice Address - Street 1:4360 BLUE DIAMOND RD STE 103
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-7785
Practice Address - Country:US
Practice Address - Phone:702-407-0524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-02
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN89025163W00000X
NV886083363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse