Provider Demographics
NPI:1770293847
Name:BALLARD, KELSEY SUE
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:SUE
Last Name:BALLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 SIOUX DR
Mailing Address - Street 2:
Mailing Address - City:RITTMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44270-1924
Mailing Address - Country:US
Mailing Address - Phone:330-317-5156
Mailing Address - Fax:
Practice Address - Street 1:32 SIOUX DR
Practice Address - Street 2:
Practice Address - City:RITTMAN
Practice Address - State:OH
Practice Address - Zip Code:44270-1924
Practice Address - Country:US
Practice Address - Phone:330-317-5156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH11111111OtherUNSURE