Healthcare Provider Details

I. General information

NPI: 1265395990
Provider Name (Legal Business Name): CAEDON BALLARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2070 VALLEYDALE RD STE 7
HOOVER AL
35244-2035
US

IV. Provider business mailing address

277 E AMADOR AVE STE 101
LAS CRUCES NM
88001-3675
US

V. Phone/Fax

Practice location:
  • Phone: 659-202-6559
  • Fax:
Mailing address:
  • Phone: 505-392-3482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: