Clarisa Ballarta Colchado, FNP
Individual provider Active NPI Family Medicine Physician · Fort Knox, KY
NPI 1013552140 · NPPES record last updated Nov 13, 2019
Key facts
- NPI
- 1013552140
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- NP95010873 (CA)
- Practice address
- 433 192ND Tank BN Road
BLDG 853
Fort Knox, KY 40121-5111 - Phone
- (502) 624-3149
- NPI assigned
- Nov 13, 2019
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NP95010873 | CA | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | NP95010873 | CA | Yes |
Addresses
Primary practice location
433 192ND Tank BN Road
BLDG 853
Fort Knox, KY 40121-5111
Mailing address
5887 Adams St # a
Fort Knox, KY 40121-2043
Phone (323) 206-2734
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NP95010873 | Other | CA | TRICARE INSURANCE- MILITARY |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | clinic | Health Information Exchange (HIE) |
Other providers in Fort Knox, KY
- Owen E Cherry
- Laurie Cheser
- Noah M Christopher
- Andraya Clark
- Rosemarie Cochran
- Lauren Elizabeth Collier
- Kimberly Ann Coomes
- Linda A Cooper
- Diana Cotter
- Hope Lloyd Cox
All providers in Fort Knox, KY · Family Medicine Physician in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 13, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.