Healthcare Provider Details

I. General information

NPI: 1679156715
Provider Name (Legal Business Name): KARIN BALLARD MS. RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S BLOUNT ST STE 103
MADISON WI
53703-4664
US

IV. Provider business mailing address

1145 AMHERST DR
MADISON WI
53705-2201
US

V. Phone/Fax

Practice location:
  • Phone: 608-405-5111
  • Fax: 608-554-1052
Mailing address:
  • Phone: 773-343-6810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number3641-29
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: