Destination Dermatology LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

PA0004388 Issued in CO

Legal business name

DESTINATION DERMATOLOGY LLC

Doing business as

Renew Dermatology

Practice address

60 Main Street
Ste F, G & H
Frisco, CO 80443

Phone

(309) 287-1909

NPI assigned

Mar 28, 2017

Last updated

Jun 16, 2026By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kelly Ann Ballou, PA-CNPI 1366467805

Title

Managing Member

Phone

(970) 409-4000

Specialties & licenses 2

Addresses

Other names 1

• Renew Dermatology Doing business as

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kelly Ballou, P.A.-C

  • Procedural Dermatology Physician
  • Frisco, CO
  • NPI 1366467805
  Medicare reassignment Authorized official
• Scott D Bennion, M.D.

  • Dermatology Physician
  • Casper, WY
  • NPI 1952317505

  CO

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1490659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781568000000",
    "number": "1205368453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 N PARK AVE",
            "address_2": "STE 12-B #1178",
            "city": "BRECKENRIDGE",
            "state": "CO",
            "postal_code": "80424",
            "telephone_number": "970-409-4000",
            "fax_number": "855-839-5617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 MAIN STREET",
            "address_2": "STE F, G & H",
            "city": "FRISCO",
            "state": "CO",
            "postal_code": "80443",
            "telephone_number": "309-287-1909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESTINATION DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-28",
        "last_updated": "2026-06-16",
        "certification_date": "2026-06-16",
        "status": "A",
        "authorized_official_last_name": "BALLOU",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "970-409-4000",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "CO",
            "license": "PA0004388",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Renew Dermatology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Renew Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Day Surgical Arts Frisco
• Teri Lynn Day, PT
• Logan Debord, MD
• Nicole Marie Denczek, PT
• Marshall Esty Denkinger Jr., MD
• Christian Abner Diaz
• Carolyn Christiano Dieter, PT
• Jeremy Dion, MA, LPC
• Kathy Ditlow, CRNFA
• Casey Donohoe, LSW

• Medical Specialty Clinic/Center in Frisco, CO
• Providers in Frisco, CO by specialty
• Medical Specialty Clinic/Center in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.