Provider Demographics
NPI:1174226799
Name:BALLARD, JASMINE JANAY
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:JANAY
Last Name:BALLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:J
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:223 WATERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE FERRY
Mailing Address - State:NJ
Mailing Address - Zip Code:07643-2222
Mailing Address - Country:US
Mailing Address - Phone:551-206-8200
Mailing Address - Fax:
Practice Address - Street 1:223 WATERSIDE DR
Practice Address - Street 2:
Practice Address - City:LITTLE FERRY
Practice Address - State:NJ
Practice Address - Zip Code:07643-2222
Practice Address - Country:US
Practice Address - Phone:551-206-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-23
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator