Active NPI
Kristina Ballard, RN
- Registered Nurse
- Grenada, MS
National Provider Identifier
1730776485
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 860917
- Practice address
- 1209 Sunset Dr
Grenada, MS 38901-4063 - Phone
- (662) 294-0665
- NPI assigned
- Dec 29, 2020
- Last updated
- Dec 29, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 860917 | MS | Primary |
Addresses
Primary practice location
1209 Sunset Dr
Grenada, MS 38901-4063
Mailing address
282 Chalet Dr
Grenada, MS 38901-9622
Phone (662) 417-4793
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 860917 | MS | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mississippi CVS Pharmacy LLC | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1609200000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609200000000",
"number": "1730776485",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "282 CHALET DR",
"city": "GRENADA",
"state": "MS",
"postal_code": "389019622",
"telephone_number": "662-417-4793"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1209 SUNSET DR",
"city": "GRENADA",
"state": "MS",
"postal_code": "389014063",
"telephone_number": "662-294-0665"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALLARD",
"first_name": "KRISTINA",
"credential": "RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-12-29",
"last_updated": "2020-12-29",
"certification_date": "2020-12-29",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MS",
"license": "860917",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grenada, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.