Healthcare Provider Details

I. General information

NPI: 1104341213
Provider Name (Legal Business Name): HEATHER BALLEW MSN-NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 S 17TH ST
WILMINGTON NC
28401-7407
US

IV. Provider business mailing address

510 CAROLINA BAY DR
WILMINGTON NC
28403-2041
US

V. Phone/Fax

Practice location:
  • Phone: 910-667-2970
  • Fax:
Mailing address:
  • Phone: 910-612-6932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5013816
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAPN.0993346-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: