Krystal Suzanne Ballot, CHP – Community Health Worker

Key facts

NPI: 1417224908
Entity type: Individual (NPI type 1)
Primary specialty: Community Health Worker 172V00000X
License: 00-378-P (AK)
Practice address: #3 Adams Landing-Old
Selawik, AK 99770-0180
Phone: (907) 484-2199
Fax: (907) 484-2119
NPI assigned: Nov 28, 2011
Sex: Female
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Maniilaq Association Federal Public Health Clinic/Center · Selawik, AK · NPI 1821365552

NPD (past)

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
00-378-P	AK	MD	Community Health Worker

Practice roles

Organization	Specialty	Status	New patients
Maniilaq Association		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Community Health Worker	172V00000X	00-378-P	AK	Yes

Addresses

Primary practice location

#3 Adams Landing-Old
Selawik, AK 99770-0180

Mailing address

#3 Adams Landing-Old
Box 180
Selawik, AK 99770-0180
Phone (907) 484-2199

Other providers in Selawik, AK

All providers in Selawik, AK · Community Health Worker in Alaska

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 28, 2011. 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.

Verify at the official NPI Registry.