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Individual
SHELBY LAUREN BALLARD
Active
Individual
SHELBY LAUREN BALLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CAA
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
75000120A
IN
367H00000X
Anesthesiologist Assistant
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1720791940
ANTHEM PTAN
IN
01
—
Q00631895
RAILROAD PTAN
IN
Enumeration date
01/03/2023
Last updated
11/21/2024
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