Provider Demographics
NPI:1508959511
Name:BALLARD, KIMBERLY D (DO)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:D
Last Name:BALLARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:GRIMMETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:252 RURAL ACRES DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3503
Mailing Address - Country:US
Mailing Address - Phone:304-252-8551
Mailing Address - Fax:304-252-1790
Practice Address - Street 1:2157 RITTER DR
Practice Address - Street 2:
Practice Address - City:DANIELS
Practice Address - State:WV
Practice Address - Zip Code:25832-9371
Practice Address - Country:US
Practice Address - Phone:304-763-4326
Practice Address - Fax:304-763-4581
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810003008Medicaid
323711OtherCARELINK
2138918OtherUNITEDHEALTHCARE
WV58606Medicaid
WV89608Medicaid
I33574OtherHEALTH NET
WVP00389008OtherMEDICARE TRAVELERS RAILRO
I33574OtherHEALTH NET
I33574Medicare UPIN
WV89608Medicaid
2138918OtherUNITEDHEALTHCARE