Provider Demographics
NPI:1902893324
Name:BALLARD, CHARLOTTE D (MSN, ENP-BC)
Entity Type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:D
Last Name:BALLARD
Suffix:
Gender:F
Credentials:MSN, ENP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6609 BLANCO RD STE 360
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6171
Mailing Address - Country:US
Mailing Address - Phone:210-600-4105
Mailing Address - Fax:
Practice Address - Street 1:6609 BLANCO RD STE 360
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6171
Practice Address - Country:US
Practice Address - Phone:210-600-4105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP107832363LA2100X, 363LF0000X, 363LP0808X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
S43144Medicare UPIN
TX8D7176Medicare ID - Type Unspecified