Basic Information
| Provider Information | |||||||||
| NPI: | 1659668465 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALLENTINE | ||||||||
| FirstName: | KELLY | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 302 COBIA DR | ||||||||
| Address2: | APT 6105 | ||||||||
| City: | KATY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774946964 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2679771536 | ||||||||
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| Practice Location | |||||||||
| Address1: | 23900 KATY FWY | ||||||||
| Address2: | |||||||||
| City: | KATY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774941323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2816447000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2011 | ||||||||
| LastUpdateDate: | 12/31/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Q6147 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.