| Doctor Name: | BRET BALLARD |
| NPI Number: | 1376564799 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | NP |
| License Number: | R815978 |
| Business Practice Address: | 1107 Earl Frye Blvd Suite 6 Amory, MS - 388215519 |
| Business Phone Number: | 6622566227 |
| Business Fax Number: | 6622566271 |
| Mailing Address: | 123 Main St N, AMORY |
| State: | MS |
| Postal Code: | 388213416 |
| Phone Number: | 6622567112 |
| Fax Number: | 6622567116 |
| NPI Enumeration Date: | 07/21/2006 |
| NPI Last Update Date: | 12/22/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | R815978 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |