Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Marty Kyle Ballard Sr., FNP

Individual provider Family Nurse Practitioner · NPI 1023622081

Marty Kyle Ballard Sr., FNP is a Nurse Practitioner in Brookhaven, Mississippi. Qualified in 2020, 6 years ago. Practices with Southern Primary Care PLLC, a 2-clinician group and accepts Medicare assignment. Licensed in Mississippi.

Years since qualifying
6
Licensed in
MS
In the registry since
2020
What do these letters mean?
FNP — Family Nurse Practitioner
A nurse practitioner who treats patients of all ages, much like a family doctor.

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Practice location Address checks out

327 N Jackson St
Brookhaven, MS 39601-3041
Phone: (601) 833-3800
Fax: (601) 833-3847
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 904046 (MS)

Record details

NPI number1023622081
Entity typeIndividual (Type 1)
GenderMale
Credentials FNP
Sole proprietorNo
NPI enumeratedSeptember 6, 2020
Last updated in NPPESMay 12, 2021
Certification dateMay 12, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Southern Primary Care Pllc — 2 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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