Healthcare Provider Details

I. General information

NPI: 1871979856
Provider Name (Legal Business Name): MARIANNA BOYLES BALLARD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2015
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER BLVD
COOKEVILLE TN
38501-4294
US

IV. Provider business mailing address

127 N OAK AVE SUITE D
COOKEVILLE TN
38501-2435
US

V. Phone/Fax

Practice location:
  • Phone: 931-783-2770
  • Fax: 931-525-1176
Mailing address:
  • Phone: 931-783-5857
  • Fax: 931-526-6760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number20392
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: