Basic Information
| Provider Information | |||||||||
| NPI: | 1295401198 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALLET | ||||||||
| FirstName: | FLEM | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3616 S I 10 SERVICE RD W STE 100 | ||||||||
| Address2: | |||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700011884 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048385257 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5001 WESTBANK EXPY STE 100 | ||||||||
| Address2: | |||||||||
| City: | MARRERO | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700722954 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5043498833 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2021 | ||||||||
| LastUpdateDate: | 09/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 363LP0808X | 226168 | LA | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.