Provider Demographics
NPI:1760452056
Name:BALLARD, LEWIS NELSON III (CRNA)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:NELSON
Last Name:BALLARD
Suffix:III
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22390
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71903
Mailing Address - Country:US
Mailing Address - Phone:800-235-1415
Mailing Address - Fax:913-234-1108
Practice Address - Street 1:1636 HIGDON FERRY RD
Practice Address - Street 2:MLK BLVD
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6912
Practice Address - Country:US
Practice Address - Phone:501-520-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC00410367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59408OtherBCBS
P00373018OtherRR MEDICARE GROUP CK 6327
AR59408OtherBCBS
AR59408Medicare ID - Type Unspecified
AR59408C752Medicare PIN