Healthcare Provider Details

I. General information

NPI: 1730877713
Provider Name (Legal Business Name): SARA CORNELISON BALLARD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 BYPASS RD
WINCHESTER KY
40391-2300
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 859-744-5111
  • Fax: 859-744-1177
Mailing address:
  • Phone: 606-330-7835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4006593
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2050867
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: