Provider Demographics
NPI:1649329731
Name:BALLARD, CINDA JOYCE (ARNP)
Entity type:Individual
Prefix:
First Name:CINDA
Middle Name:JOYCE
Last Name:BALLARD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 950257
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0257
Mailing Address - Country:US
Mailing Address - Phone:502-969-6552
Mailing Address - Fax:502-969-3799
Practice Address - Street 1:720 W HILL ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-2216
Practice Address - Country:US
Practice Address - Phone:502-636-3164
Practice Address - Fax:502-634-3731
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3857P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY096484OtherSIHO - NLPCC
KY3525229000OtherPASSPORT ADVTG - NLPCC
KY78009719Medicaid
KY098856OtherSIHO - NORTON ICC
KY000000568032OtherANTHEM - NLPCC
KY50019417OtherPASSPORT - NLPCC
KY0042308OtherMEDICARE - KY - NLPCC
KY000000568032OtherANTHEM - NLPCC