Basic Information
| Provider Information | |||||||||
| NPI: | 1659347466 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BALLARD | ||||||||
| FirstName: | KACY | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5151 REED RD STE 105B | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432202595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144572306 | ||||||||
| FaxNumber: | 6148840776 | ||||||||
| Practice Location | |||||||||
| Address1: | 5151 REED RD STE 105B | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432202595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144572306 | ||||||||
| FaxNumber: | 6148840776 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2006 | ||||||||
| LastUpdateDate: | 04/16/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN-294528 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 2304965 | 05 | OH | MEDICAID |