Provider Demographics
NPI:1073065355
Name:BALLARD, VANESSA (DNP, ATC)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:BALLARD
Suffix:
Gender:F
Credentials:DNP, ATC
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:YOLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:1010 WAYNE AVE STE 410
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-5655
Mailing Address - Country:US
Mailing Address - Phone:240-600-0177
Mailing Address - Fax:
Practice Address - Street 1:1010 WAYNE AVE STE 410
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-5655
Practice Address - Country:US
Practice Address - Phone:240-600-0177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-02
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00017542255A2300X
VA01260043382255A2300X
MDR274119363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer