Healthcare Provider Details

I. General information

NPI: 1437029477
Provider Name (Legal Business Name): BENJAMIN BALLARD NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2025
Last Update Date: 11/06/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16515 S 40TH ST STE 143
PHOENIX AZ
85048-0560
US

IV. Provider business mailing address

21028 E ESTRELLA RD
QUEEN CREEK AZ
85142-5594
US

V. Phone/Fax

Practice location:
  • Phone: 480-712-8319
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number330738
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: