Basic Information
| Provider Information | |||||||||
| NPI: | 1689624488 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALLARD | ||||||||
| FirstName: | LAURI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4300 CITY POINT DR STE 201 | ||||||||
| Address2: | |||||||||
| City: | NORTH RICHLAND HILLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761808338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172848222 | ||||||||
| FaxNumber: | 8175955718 | ||||||||
| Practice Location | |||||||||
| Address1: | 4300 CITY POINT DR | ||||||||
| Address2: | STE 200 | ||||||||
| City: | NORTH RICHLAND HILLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761808380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172551940 | ||||||||
| FaxNumber: | 8172551977 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2006 | ||||||||
| LastUpdateDate: | 05/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | L3917 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8050B6 | 01 | TX | BCBS | OTHER | 152493603 | 01 | TX | MEDICAID - TARRANT | OTHER | 152493601 | 05 | TX | MEDICAID |