Provider Demographics
NPI:1497906234
Name:BALLARD, SARAH A (PA-C)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:A
Last Name:BALLARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 E ALEX BELL RD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-2658
Mailing Address - Country:US
Mailing Address - Phone:937-435-6400
Mailing Address - Fax:937-435-4793
Practice Address - Street 1:1235 E ALEX BELL RD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-2658
Practice Address - Country:US
Practice Address - Phone:937-435-6400
Practice Address - Fax:937-435-4793
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2014-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-002821363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH50002821OtherSTATE LICNSE
OH55.000765OtherSTATE PRESCRIBING LICENSE NUMBER