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General NPI Number Information
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NPI Number | 1902662794
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Entity Type | Individual
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Provider Name | THANDIWE J BALLARD CNP
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Gender | Female
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Dates
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Enumeration Date | 02/28/2024
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 2555 S DIXIE DR STE 260A
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City | DAYTON
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State | OH
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Zip | 45409-1542
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Country | US
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Telephone | 937-350-1640
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Fax | 937-530-4194
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Provider Business Mailing Address
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Address Line | 5676 BELLEFONTAINE RD
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City | HUBER HEIGHTS
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State | OH
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Zip | 45424-4135
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Country | US
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Telephone | 937-813-0060
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Fax | 937-530-4194
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN.CNP.0035847
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License Number State | OH
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