Provider Demographics
NPI:1639663594
Name:BALLARD, STEPHEN NOTFOUND SR
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:NOTFOUND
Last Name:BALLARD
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14213 E 33RD ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74134-4430
Mailing Address - Country:US
Mailing Address - Phone:918-313-5173
Mailing Address - Fax:
Practice Address - Street 1:14213 E 33RD ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74134-4430
Practice Address - Country:US
Practice Address - Phone:918-313-5173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator