Provider Demographics
NPI:1669490918
Name:BALLARD, KATHY (NNP)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:BALLARD
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5414 FREDERICKSBURG RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3641
Mailing Address - Country:US
Mailing Address - Phone:210-541-8281
Mailing Address - Fax:210-541-9123
Practice Address - Street 1:5414 FREDERICKSBURG RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3641
Practice Address - Country:US
Practice Address - Phone:210-541-8281
Practice Address - Fax:210-541-9123
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX616084163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXNURSING LICENSEOther616084