Provider Demographics
NPI:1336104934
Name:LADD, KYLEE J (PA)
Entity type:Individual
Prefix:
First Name:KYLEE
Middle Name:J
Last Name:LADD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3832 GRASSMERE RD
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8234
Mailing Address - Country:US
Mailing Address - Phone:802-782-7500
Mailing Address - Fax:
Practice Address - Street 1:1160 E OGDEN AVE STE 106
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-2693
Practice Address - Country:US
Practice Address - Phone:331-226-0315
Practice Address - Fax:331-226-0315
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT055-0030279363AM0700X
IL085-005152363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT9000230Medicaid
VT9000230Medicaid