Provider Demographics
NPI:1992826812
Name:BALLARD, BEVERLY ANN
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:ANN
Last Name:BALLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 CLEAR CREEK DR
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-6676
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 W CAMPBELL RD
Practice Address - Street 2:SUITE SU 1.606 MS-SU25
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3021
Practice Address - Country:US
Practice Address - Phone:972-883-2747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-27076363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health