Healthcare Provider Details

I. General information

NPI: 1871521252
Provider Name (Legal Business Name): KATHERINE E. BALLARD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2416 REGENCY ROAD
LEXINGTON KY
40503
US

IV. Provider business mailing address

280 PASADENA DR
LEXINGTON KY
40503-2925
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-1316
  • Fax: 859-260-2470
Mailing address:
  • Phone: 859-278-1316
  • Fax: 859-685-0340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number40989
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number40989
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: