Provider Demographics
NPI:1891001772
Name:BALLARD, ARDEN N II (PA-C)
Entity Type:Individual
Prefix:
First Name:ARDEN
Middle Name:N
Last Name:BALLARD
Suffix:II
Gender:M
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 1:100 COVINGTON ST UNIT 1166
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-5048
Mailing Address - Country:US
Mailing Address - Phone:985-231-2151
Mailing Address - Fax:
Practice Address - Street 1:2735 HIGHWAY 190 STE D
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3433
Practice Address - Country:US
Practice Address - Phone:985-778-2510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200427.RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05775557Medicaid
LA2386824Medicaid
LA2386824Medicaid