MEDICARE: MISS MEGAN K BALLAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	CAPN0000251CNP	CO
2	363LF0000X	Family Nurse Practitioner	CNP-02481	NM
3	363LF0000X	Family Nurse Practitioner	105652	OK

General Provider Information

NPI Number	:	1245632884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MEGAN K BALLAS

Provider Business Mailing Address
First Line	:	P. O. BOX 30589
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73140-1156
Country	:	US
Telephone Number	:	405-769-3301
Fax Number	:	405-769-9685

Provider Business Practice Location Address
First Line	:	105 E. SANTA FE
Second Line	:	DOROTHY SMITH FAMILY MEDICAL CLINIC
City	:	CARNEY
State	:	OK
Zip	:	74832
Country	:	US
Telephone Number	:	405-865-2020
Fax Number	:	405-865-2323

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2014
Last Update Date	:	04/23/2021

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Directions to “ MISS MEGAN K BALLAS ” Practice Location

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