Provider Demographics
NPI:1831557669
Name:BALLARD, ANDREA (NP)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
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 1:1 AYER CIR BLDG H1
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03804-4402
Mailing Address - Country:US
Mailing Address - Phone:207-438-5981
Mailing Address - Fax:207-438-1527
Practice Address - Street 1:1 AYER CIR BLDG H1
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03804-4402
Practice Address - Country:US
Practice Address - Phone:207-438-5981
Practice Address - Fax:207-438-1527
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-08
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA206875363LF0000X
NH037046-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily