Provider Demographics
NPI:1407121635
Name:BALLARD FAMILY MEDICAL, INC
Entity type:Organization
Organization Name:BALLARD FAMILY MEDICAL, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:931-392-4749
Mailing Address - Street 1:100 3RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-1570
Mailing Address - Country:US
Mailing Address - Phone:931-392-4749
Mailing Address - Fax:931-967-0284
Practice Address - Street 1:100 3RD AVE SE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-1570
Practice Address - Country:US
Practice Address - Phone:931-392-4749
Practice Address - Fax:931-967-0284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN08389363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty