Provider Demographics
NPI:1487066007
Name:BALLARD, JILL (RD,LDN)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:BALLARD
Suffix:
Gender:F
Credentials:RD,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18811 LA HIGHWAY 42
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:LA
Mailing Address - Zip Code:70754-4039
Mailing Address - Country:US
Mailing Address - Phone:225-571-2126
Mailing Address - Fax:225-686-1782
Practice Address - Street 1:18811 LA HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:LA
Practice Address - Zip Code:70754-4039
Practice Address - Country:US
Practice Address - Phone:225-571-2126
Practice Address - Fax:225-686-1782
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2385133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered