Healthcare Provider Details

I. General information

NPI: 1730637224
Provider Name (Legal Business Name): JESSICA BALLARD DNP, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 NEALY AVENUE
JOINT BASE LANGLEY-EUSTIS VA
23665
US

IV. Provider business mailing address

77 NEALY AVENUE
JOINT BASE LANGLEY-EUSTIS VA
23665
US

V. Phone/Fax

Practice location:
  • Phone: 757-764-8290
  • Fax:
Mailing address:
  • Phone: 757-764-8290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberRN185372
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP8891
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: