Provider Demographics
NPI:1902969587
Name:BALLARD, PATSY ANN (FNPC)
Entity Type:Individual
Prefix:MRS
First Name:PATSY
Middle Name:ANN
Last Name:BALLARD
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2166 ELLIS ROAD
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:NY
Mailing Address - Zip Code:14837
Mailing Address - Country:US
Mailing Address - Phone:315-531-2944
Mailing Address - Fax:
Practice Address - Street 1:418 N MAIN ST
Practice Address - Street 2:KEUKA HEALTH CARE
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527-1070
Practice Address - Country:US
Practice Address - Phone:315-531-2944
Practice Address - Fax:315-536-0430
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3318891363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02218688Medicaid
P09894Medicare UPIN
NY02218688Medicaid