Provider Demographics
NPI:1275852691
Name:BALLARD, PATRICIA A (LPN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:BALLARD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13796 STATE ROUTE 122
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45064-9556
Mailing Address - Country:US
Mailing Address - Phone:937-787-3287
Mailing Address - Fax:
Practice Address - Street 1:13796 STATE ROUTE 122
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45064-9556
Practice Address - Country:US
Practice Address - Phone:937-787-3287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH138099164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse