Provider Demographics
NPI:1093806838
Name:BALLARD, REGINA GAIL (ARNP)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:GAIL
Last Name:BALLARD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:GOWEN
Mailing Address - State:OK
Mailing Address - Zip Code:74545-0087
Mailing Address - Country:US
Mailing Address - Phone:918-470-7014
Mailing Address - Fax:918-423-4905
Practice Address - Street 1:810 S GEORGE NIGH EXPY
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-7279
Practice Address - Country:US
Practice Address - Phone:918-423-4900
Practice Address - Fax:918-423-4905
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0078895363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics