Healthcare Provider Details

I. General information

NPI: 1538684857
Provider Name (Legal Business Name): SARAH BALLINGER NPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH MITCHELL APRN

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date: 06/04/2018
Reactivation Date: 06/12/2018

III. Provider practice location address

2969 CURRAN DR N STE 200
JACKSON MS
39216
US

IV. Provider business mailing address

1227 N STATE ST STE 101
JACKSON MS
39202-2002
US

V. Phone/Fax

Practice location:
  • Phone: 601-974-5600
  • Fax: 601-974-5699
Mailing address:
  • Phone: 601-974-5637
  • Fax: 601-974-5605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number902023
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: