Provider Demographics
NPI:1215013073
Name:BALLARD, DEANNA DANELL (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:DANELL
Last Name:BALLARD
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:115 TANGLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4525
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:308 HIGHLAND BLVD
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4611
Practice Address - Country:US
Practice Address - Phone:601-442-7676
Practice Address - Fax:601-442-9590
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR691941363LF0000X
LARN066376 APO4870363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06809362Medicaid
LA1529052Medicaid