Provider Demographics
NPI:1871521252
Name:BALLARD, KATHERINE E (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:E
Last Name:BALLARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 PASADENA DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2925
Mailing Address - Country:US
Mailing Address - Phone:859-278-1316
Mailing Address - Fax:859-685-0340
Practice Address - Street 1:2416 REGENCY ROAD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503
Practice Address - Country:US
Practice Address - Phone:859-278-1316
Practice Address - Fax:859-260-2470
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40989208VP0014X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000541465OtherBC/BS
1237125OtherCHA
KY7100031340Medicaid
KY0366233Medicare PIN
KY0688826Medicare PIN