Healthcare Provider Details

I. General information

NPI: 1689902934
Provider Name (Legal Business Name): CALLIE S BALLENGER APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2009
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 E 23RD ST S
INDEPENDENCE MO
64055-1670
US

IV. Provider business mailing address

7900 LEES SUMMIT RD
KANSAS CITY MO
64139-1236
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-9800
  • Fax:
Mailing address:
  • Phone: 816-404-7600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberTMP140303
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2009035922
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: