MEDICARE: KATIE MAUREEN BALLARD FNP-C

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
1	363LF0000X	Family Nurse Practitioner	F07170127	CO

General Provider Information

NPI Number	:	1780108159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE MAUREEN BALLARD FNP-C

Provider Business Mailing Address
First Line	:	5646 JELLISON ST
Second Line	:
City	:	ARVADA
State	:	CO
Zip	:	80002-2145
Country	:	US
Telephone Number	:	303-261-2173
Fax Number	:

Provider Business Practice Location Address
First Line	:	8601 TURNPIKE DR UNIT 200
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80031-7044
Country	:	US
Telephone Number	:	303-428-7449
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2017
Last Update Date	:	07/27/2017

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