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General NPI Number Information
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NPI Number | 1366467805
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Entity Type | Individual
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Provider Name | KELLY BALLOU P.A.-C
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Gender | Female
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 03/28/2017
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Provider Practice Location Address
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Address Line | 60 MAIN STREET STE F,G,H BEAVER PLAZA CONDO
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City | FRISCO
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State | CO
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Zip | 80443
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Country | US
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Telephone | 309-287-1909
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Fax |
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Provider Business Mailing Address
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Address Line | 265 DILLON RIDGE RD SUITE C402
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City | DILLON
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State | CO
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Zip | 80435-6009
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Country | US
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Telephone | 309-287-1909
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA0004388
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License Number State | CO
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