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Individual

KEVIN D BALLARD

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
NP

Contact information

Practice address
323 S MINNESOTA ST, CROOKSTON, MN 56716-1601
(218) 253-4606
Mailing address
323 S MINNESOTA ST, CROOKSTON, MN 56716-1601
(218) 253-4606

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R28679
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
142320
UCARE #
MN
01
19666
ND MA
ND
05
19961
ND
01
23441
ND BC
MN
01
365Y6BA
BC MN
MN
05
726183700
MN
Enumeration date
06/05/2006
Last updated
09/19/2009
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