Provider Demographics
NPI:1720409014
Name:RALSTON, ERNEST KIMBLE (CCEMTP-T, IDC, EPIDE)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:KIMBLE
Last Name:RALSTON
Suffix:
Gender:M
Credentials:CCEMTP-T, IDC, EPIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14519 CREEK BRANCH CT
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-1358
Mailing Address - Country:US
Mailing Address - Phone:703-226-9192
Mailing Address - Fax:
Practice Address - Street 1:14519 CREEK BRANCH CT
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-1358
Practice Address - Country:US
Practice Address - Phone:703-226-9192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-03
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN3016-2852146L00000X
171000000X, 1710I1002X, 174H00000X, 146L00000X
VA031005926146N00000X
FL527845146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
No1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
No174H00000XOther Service ProvidersHealth Educator