Healthcare Provider Details

I. General information

NPI: 1194645648
Provider Name (Legal Business Name): JAYCE LAINE BALLINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19801 FLINT RD
BROWNING MO
64630-8154
US

IV. Provider business mailing address

19801 FLINT RD
BROWNING MO
64630-8154
US

V. Phone/Fax

Practice location:
  • Phone: 660-247-0315
  • Fax:
Mailing address:
  • Phone: 660-247-0315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2025047054
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: