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General NPI Number Information
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NPI Number | 1407121635
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Entity Type | Organization
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Legal Business Name | BALLARD FAMILY MEDICAL, INC
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Dates
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Enumeration Date | 03/21/2012
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Last Update Date | 03/30/2023
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Provider Practice Location Address
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Address Line | 100 3RD AVE SE
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City | WINCHESTER
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State | TN
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Zip | 37398-1570
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Country | US
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Telephone | 931-392-4749
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Fax | 931-967-0284
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Provider Business Mailing Address
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Address Line | 100 3RD AVE SE
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City | WINCHESTER
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State | TN
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Zip | 37398-1570
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Country | US
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Telephone | 931-392-4749
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Fax | 931-967-0284
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Authorized Official
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Title or Position | PROVIDER
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Name | MRS. BRANDY DENISE BALLARD
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Credential | FNP
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Telephone | 931-392-4749
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN08389
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License Number State | TN
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