Provider Demographics
NPI:1033643176
Name:BALLARD, ZACHARY THOMAS (PMHNP, MS)
Entity Type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:THOMAS
Last Name:BALLARD
Suffix:
Gender:M
Credentials:PMHNP, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6240 KARLSRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-8402
Mailing Address - Country:US
Mailing Address - Phone:937-694-4563
Mailing Address - Fax:
Practice Address - Street 1:6240 KARLSRIDGE DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-8402
Practice Address - Country:US
Practice Address - Phone:937-694-4563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-15
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN. 391021163W00000X
OHAPRN.CNP.0032677363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse