Kevin Balderas, PHARM.D.

Primary specialty

PharmacistTaxonomy code 183500000X

License

69493 Issued in TX

Practice address

4350 Oak Park LN
Fort Worth, TX 76109-1512

Phone

(817) 920-0600

NPI assigned

Sep 20, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

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

{
    "created_epoch": "1632096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632096000000",
    "number": "1407526452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 HULEN PL APT 209",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761077298",
            "telephone_number": "210-332-2311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4350 OAK PARK LN",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761091512",
            "telephone_number": "817-920-0600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALDERAS",
        "first_name": "KEVIN",
        "name_prefix": "Dr.",
        "credential": "PHARM.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-20",
        "last_updated": "2021-09-20",
        "certification_date": "2021-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TX",
            "license": "69493",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "NA",
            "affiliation": "N",
            "address_1": "4350 Oak Park Ln",
            "city": "Fort Worth",
            "state": "TX",
            "country_code": "US",
            "postal_code": "761091512",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Balch Interventional Pain and Wellness Center PLLC
• Cayli Nguyen Balch, D.O.
• Robert Judson Balch III, D.O.
• Susan Alice Baldelomar, L.P.C.
• Jasmine Balderas
• Cayla Howell Baldock
• Diane Lynn Baldwin
• Jesse Baldwin, MS
• Kathleen M. Baldwin, ANP, GNP, CNS
• Krystal R. Baldwin, DDS

• Pharmacist in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Pharmacist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.