Provider Demographics
NPI:1255717088
Name:BALLARD, TONJANIKA (PMHNP)
Entity type:Individual
Prefix:
First Name:TONJANIKA
Middle Name:
Last Name:BALLARD
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 FITZHUGH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3531
Mailing Address - Country:US
Mailing Address - Phone:804-464-8340
Mailing Address - Fax:804-884-3726
Practice Address - Street 1:4901 FITZHUGH AVE STE 200
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3531
Practice Address - Country:US
Practice Address - Phone:804-464-8340
Practice Address - Fax:804-884-3726
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172800363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health