Nicole Sakura Ballard
Individual provider Active NPI Psychiatric/Mental Health Registered Nurse · Spanish Fork, UT
NPI 1053114231 · NPPES record last updated Mar 31, 2025
Key facts
- NPI
- 1053114231
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Registered Nurse 163WP0808X
- License
- 118393123102 (UT)
- Practice address
- 2172 E 7200 S
Spanish Fork, UT 84660-9340 - Phone
- (866) 805-1199
- NPI assigned
- Mar 31, 2025
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 118393123102 | UT | MD | Psychiatric/Mental Health Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Registered Nurse | 163WP0808X | 118393123102 | UT | Yes |
Addresses
Primary practice location
2172 E 7200 S
Spanish Fork, UT 84660-9340
Mailing address
5500 Ming Ave Ste 410
Bakersfield, CA 93309-4631
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 118393123102 | Other | UT | RN LICENSE |
Other providers in Spanish Fork, UT
- Back on Track Family Chiropractic, LLC
- David Albert Baggaley
- Nicolas Baird
- David R Baker
- Lureta Corrine Ballard
- Sargent Doil Barnett
- Allison Marie Barney
- Andrea Barney
- Kendall James Barrowes
- Lezlie Anne Bartholomew
All providers in Spanish Fork, UT · Psychiatric/Mental Health Registered Nurse in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 31, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.