Provider Demographics
NPI:1003893066
Name:BALLARD, STACY L (MD)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:L
Last Name:BALLARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:STACY
Other - Middle Name:L
Other - Last Name:NOYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2317 91ST CRES N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-3855
Mailing Address - Country:US
Mailing Address - Phone:612-209-2814
Mailing Address - Fax:
Practice Address - Street 1:2317 91ST CRES N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-3855
Practice Address - Country:US
Practice Address - Phone:612-209-2814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2025-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND14090207V00000X
MN41031207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology