Provider Demographics
NPI:1023591617
Name:LAURIE K. BALLEW
Entity type:Organization
Organization Name:LAURIE K. BALLEW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:BALLEW
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:270-558-4174
Mailing Address - Street 1:657 LONE OAK RD STE 2
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-4547
Mailing Address - Country:US
Mailing Address - Phone:270-558-4174
Mailing Address - Fax:270-534-5753
Practice Address - Street 1:657 LONE OAK RD STE 2
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-4547
Practice Address - Country:US
Practice Address - Phone:270-558-4174
Practice Address - Fax:270-534-5753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-11
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2436OtherMEDICAL LICENSE