Provider Demographics
NPI:1780108159
Name:BALLARD, KATIE MAUREEN (FNP-C)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:MAUREEN
Last Name:BALLARD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5646 JELLISON ST
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-2145
Mailing Address - Country:US
Mailing Address - Phone:303-261-2173
Mailing Address - Fax:
Practice Address - Street 1:8601 TURNPIKE DR UNIT 200
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-7044
Practice Address - Country:US
Practice Address - Phone:303-428-7449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COF07170127363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily