Individual
MARTY KYLE BALLARD SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
327 N JACKSON ST, BROOKHAVEN, MS 39601-3041
(601) 833-3800
(601) 833-3847
Mailing address
698 LOWER BROOKHAVEN RD, MONTICELLO, MS 39654-9627
(160) 145-5760
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
904046
MS
Other
Enumeration date
09/06/2020
Last updated
05/12/2021
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