Provider Demographics
NPI:1174290761
Name:BALLARD, RACHEL LYNNE
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:LYNNE
Last Name:BALLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:LYNNE
Other - Last Name:O'NEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9751 US HIGHWAY 52 S
Mailing Address - Street 2:
Mailing Address - City:CLARKS HILL
Mailing Address - State:IN
Mailing Address - Zip Code:47930-9207
Mailing Address - Country:US
Mailing Address - Phone:765-418-7272
Mailing Address - Fax:
Practice Address - Street 1:3067 E WARM SPRINGS RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3750
Practice Address - Country:US
Practice Address - Phone:702-710-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPI028390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program