Individual
KRYSTA BALLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
117 E RAY FINE BLVD, ROLAND, OK 74954-5198
(918) 427-3344
Mailing address
479389 E 1060 RD., MULDROW, OK 74948
(479) 739-5478
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
L0054032
OK
Other
Enumeration date
04/02/2021
Last updated
04/01/2025
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