Individual
CLARISA BALLARTA COLCHADO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
433 192ND TANK BN ROAD, BLDG 853, FORT KNOX, KY 40121-5111
(502) 624-3149
Mailing address
5887 ADAMS ST # A, FORT KNOX, KY 40121-2043
(323) 206-2734
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
NP95010873
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NP95010873
TRICARE INSURANCE- MILITARY
CA
Enumeration date
11/13/2019
Last updated
11/13/2019
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