Individual
KATHLEEN BALLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1501 KINGS HWY, DEPARTMENT OF MEDICINE, SHREVEPORT, LA 71103-4228
(318) 675-7636
(318) 675-5666
Mailing address
1512 W KIRBY PL, SHREVEPORT, LA 71103-3822
(318) 626-0287
(318) 629-4833
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP04387
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1581712
—
LA
01
—
4H091F600
MEDICARE - PTAN
LA
Enumeration date
07/24/2006
Last updated
08/23/2023
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