MEDICARE: DARRELL BALLARD

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	172V00000X	Community Health Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194118455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARRELL BALLARD

Provider Business Mailing Address
First Line	:	4104 HERBLINDA LN
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-2707
Country	:	US
Telephone Number	:	702-351-1416
Fax Number	:

Provider Business Practice Location Address
First Line	:	4104 HERBLINDA LN
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-2707
Country	:	US
Telephone Number	:	702-351-1416
Fax Number	:

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

Provider Enumeration Date	:	03/11/2015
Last Update Date	:	03/11/2015

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Directions to “ DARRELL BALLARD ” Practice Location

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