Provider Demographics
NPI:1053411355
Name:BALLARD, TIMOTHY EUGENE (ACNP)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:EUGENE
Last Name:BALLARD
Suffix:
Gender:M
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 PARKSIDE DR STE 331
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-1922
Mailing Address - Country:US
Mailing Address - Phone:865-647-3400
Mailing Address - Fax:865-392-3449
Practice Address - Street 1:10800 PARKSIDE DR STE 331
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1922
Practice Address - Country:US
Practice Address - Phone:865-392-3400
Practice Address - Fax:865-392-3449
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12329363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ017562Medicaid
TN3644740Medicare PIN
P00841513Medicare PIN
P00402549Medicare PIN
TNQ75200Medicare UPIN
TN3644740Medicaid
TN103I500784Medicare PIN