MEDICARE: LORRI KAY BALLARD PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1117775	TX

General Provider Information

NPI Number	:	1124717434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORRI KAY BALLARD PMHNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 1816
Second Line	:
City	:	HURST
State	:	TX
Zip	:	76053-1816
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5901 S COOPER ST STE 131
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-4417
Country	:	US
Telephone Number	:	817-200-6680
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2023
Last Update Date	:	12/28/2023

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