Provider Demographics
NPI:1861212615
Name:BALLARD, GABRIELLE R
Entity type:Individual
Prefix:MRS
First Name:GABRIELLE
Middle Name:R
Last Name:BALLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18918 DALTON VIEW CT
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63034-1545
Mailing Address - Country:US
Mailing Address - Phone:314-398-0203
Mailing Address - Fax:
Practice Address - Street 1:18918 DALTON VIEW CT
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63034-1545
Practice Address - Country:US
Practice Address - Phone:314-398-0203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOP052259006374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula