Provider Demographics
NPI:1538615570
Name:BALLARD, HEATHER D (APRN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:D
Last Name:BALLARD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:D
Other - Last Name:LYELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1029 MEDICAL CENTER CIR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-1189
Mailing Address - Country:US
Mailing Address - Phone:270-351-4575
Mailing Address - Fax:270-251-4577
Practice Address - Street 1:1029 MEDICAL CENTER CIR
Practice Address - Street 2:SUITE 306
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-1189
Practice Address - Country:US
Practice Address - Phone:270-351-4575
Practice Address - Fax:270-251-4577
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010642363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner