Healthcare Provider Details

I. General information

NPI: 1003893066
Provider Name (Legal Business Name): STACY L BALLARD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACY L NOYES M.D.

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 07/06/2025
Certification Date: 07/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2317 91ST CRES N
BROOKLYN PARK MN
55443-3855
US

IV. Provider business mailing address

2317 91ST CRES N
BROOKLYN PARK MN
55443-3855
US

V. Phone/Fax

Practice location:
  • Phone: 612-209-2814
  • Fax:
Mailing address:
  • Phone: 612-209-2814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number14090
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number41031
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: