Healthcare Provider Details

I. General information

NPI: 1427599653
Provider Name (Legal Business Name): JENNIFER BALLINGER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 NEWMAN RD
NEW BERN NC
28562-5239
US

IV. Provider business mailing address

PO BOX 68 ROOM 680
POLLOCKSVILLE NC
28573-0068
US

V. Phone/Fax

Practice location:
  • Phone: 252-633-2712
  • Fax: 252-633-5418
Mailing address:
  • Phone: 252-276-7706
  • Fax: 252-224-0378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number2022-00606
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: