NPI 1366467805 · live from the CMS NPI Registry
Kelly Ballou, P.A.-C
Dermatology, Procedural Dermatology in Frisco, CO. National Provider Identifier 1366467805, active.
NPI record
| NPI | 1366467805 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dermatology, Procedural Dermatology 207NS0135X |
| Practice location | 60 Main Street, Ste F,G,H Beaver Plaza Condo, Frisco, CO 80443 |
| Practice phone | 309-287-1909 |
| Mailing address | 400 N Park Ave, Ste 12-B #1178, Breckenridge, CO 80424 |
| Enumerated | July 13, 2006 |
| Last updated | June 21, 2026 |
| Sole proprietor | Yes |
| Other names | Kelly Gaba |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dermatology, Procedural Dermatology primary | 207NS0135X | PA0004388 (CO) |
| Physician Assistant | 363A00000X | PA0004388 (CO) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.