Provider Demographics
NPI:1942580048
Name:MANN, BALLARD JACKSON (PA)
Entity Type:Individual
Prefix:
First Name:BALLARD
Middle Name:JACKSON
Last Name:MANN
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-526-0006
Mailing Address - Fax:225-765-9291
Practice Address - Street 1:6516 E MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:LA
Practice Address - Zip Code:70714-4348
Practice Address - Country:US
Practice Address - Phone:225-774-7320
Practice Address - Fax:225-774-5432
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2021-01-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA200461363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant