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NPI Code Detail

MEDICARE: KELLY RENEE BALLEW

MEDICARE: KELLY RENEE BALLEW
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
1101YA0400XAddiction (Substance Use Disorder) Counselor12889CA

General Provider Information

NPI Number : 1629923842
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY RENEE BALLEW
Provider Business Mailing Address
First Line : 5801 SUNDALE AVE
Second Line :
City : BAKERSFIELD
State : CA
Zip : 93309-2924
Country : US
Telephone Number : 661-827-3100
Fax Number :
Provider Business Practice Location Address
First Line : 5801 SUNDALE AVE
Second Line :
City : BAKERSFIELD
State : CA
Zip : 93309-2924
Country : US
Telephone Number : 661-827-3100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2026
Last Update Date : 03/03/2026

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Directions to “ KELLY RENEE BALLEW ” Practice Location

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