Provider Demographics
NPI:1972026219
Name:BALLARD, ALLISON RAE (FNP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:RAE
Last Name:BALLARD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2709
Mailing Address - Country:US
Mailing Address - Phone:303-415-5199
Mailing Address - Fax:303-415-5198
Practice Address - Street 1:6685 GUNPARK DR STE 102
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-3343
Practice Address - Country:US
Practice Address - Phone:303-415-5199
Practice Address - Fax:303-415-5198
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.0124135163W00000X
COAPN.0993228-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse