Healthcare Provider Details

I. General information

NPI: 1346161353
Provider Name (Legal Business Name): TESSA BALLARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 E WASHINGTON ST
INDIANAPOLIS IN
46201-3847
US

IV. Provider business mailing address

5757 SAN CLEMENTE DR
INDIANAPOLIS IN
46226-1121
US

V. Phone/Fax

Practice location:
  • Phone: 317-632-0123
  • Fax: 317-423-0608
Mailing address:
  • Phone: 765-661-2102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28260923A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: