Healthcare Provider Details

I. General information

NPI: 1093806838
Provider Name (Legal Business Name): REGINA GAIL BALLARD ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 S GEORGE NIGH EXPY
MCALESTER OK
74501-7279
US

IV. Provider business mailing address

PO BOX 87
GOWEN OK
74545-0087
US

V. Phone/Fax

Practice location:
  • Phone: 918-423-4900
  • Fax: 918-423-4905
Mailing address:
  • Phone: 918-470-7014
  • Fax: 918-423-4905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR0078895
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: