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NPI Code Detail

MEDICARE: KATY BALLARD

MEDICARE: KATY BALLARD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1346634821
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATY BALLARD
Provider Business Mailing Address
First Line : PO BOX 837
Second Line :
City : FREDONIA
State : AZ
Zip : 86022-0837
Country : US
Telephone Number : 435-689-1914
Fax Number :
Provider Business Practice Location Address
First Line : 351 W UNIVERSITY BLVD
Second Line :
City : CEDAR CITY
State : UT
Zip : 84720-2415
Country : US
Telephone Number : 435-586-7700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2015
Last Update Date : 03/24/2015

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Directions to “ KATY BALLARD ” Practice Location

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