Healthcare Provider Details

I. General information

NPI: 1487769634
Provider Name (Legal Business Name): VICKI BALLARD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 E MAIN ST
OLNEY IL
62450-2619
US

IV. Provider business mailing address

723 E MAIN ST
OLNEY IL
62450-2619
US

V. Phone/Fax

Practice location:
  • Phone: 618-393-7732
  • Fax: 618-395-3123
Mailing address:
  • Phone: 618-393-7732
  • Fax: 618-395-3123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number41184984
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: