Provider Demographics
NPI:1699784348
Name:BALLARD, DANNY MACK (CRNA)
Entity type:Individual
Prefix:MR
First Name:DANNY
Middle Name:MACK
Last Name:BALLARD
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12900 BART MORELAND DR
Mailing Address - Street 2:
Mailing Address - City:ROLAND
Mailing Address - State:AR
Mailing Address - Zip Code:72135-9645
Mailing Address - Country:US
Mailing Address - Phone:501-868-4522
Mailing Address - Fax:
Practice Address - Street 1:4300 WEST 7TH STREET
Practice Address - Street 2:CENTRAL ARKANSAS VHS
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-9918
Practice Address - Country:US
Practice Address - Phone:501-257-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC00215 CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered