Provider Demographics
NPI:1265013759
Name:BALLARD, HALEY AMY-RENEE
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:AMY-RENEE
Last Name:BALLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 N FORK RD
Mailing Address - Street 2:
Mailing Address - City:BARNARDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28709-8707
Mailing Address - Country:US
Mailing Address - Phone:828-450-0895
Mailing Address - Fax:
Practice Address - Street 1:4 VANDERBILT PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2476
Practice Address - Country:US
Practice Address - Phone:828-258-9533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-11551363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant