Individual
BENJAMIN BALLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
750 N FREEDOM BLVD, PROVO, UT 84601-1677
(801) 373-4760
Mailing address
750 N FREEDOM BLVD, PROVO, UT 84601-1677
(801) 373-4760
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
12187209-3102
UT
163WP0808X
Psychiatric/Mental Health Registered Nurse
12187209-3102
UT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
12187209-4405
UT
Other
Enumeration date
03/23/2023
Last updated
09/10/2025
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