Provider Demographics
NPI:1538200530
Name:BALLARD, KAREN KAY (NP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:KAY
Last Name:BALLARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 W. SOUTHERN AVE
Mailing Address - Street 2:CONCENTRA - MESA
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85034
Mailing Address - Country:US
Mailing Address - Phone:480-644-7900
Mailing Address - Fax:
Practice Address - Street 1:1710 W. SOUTHERN AVE
Practice Address - Street 2:CONCENTRA - MESA
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85034
Practice Address - Country:US
Practice Address - Phone:219-392-7424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-11
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001475A363LA2200X
AZAP4594363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health