MEDICARE: KENYA J BALLARD NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	590736	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	590726	OTHER	TX	LICENSE
2	8N8227	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1245334879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENYA J BALLARD NP

Provider Business Mailing Address
First Line	:	9554 COUNTY ROAD 2440
Second Line	:
City	:	ROYSE CITY
State	:	TX
Zip	:	75189-3082
Country	:	US
Telephone Number	:	214-552-8606
Fax Number	:

Provider Business Practice Location Address
First Line	:	8154 COUNTY ROAD 2419
Second Line	:
City	:	ROYSE CITY
State	:	TX
Zip	:	75189-2831
Country	:	US
Telephone Number	:	214-552-8606
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	01/14/2021

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