Healthcare Provider Details

I. General information

NPI: 1316669906
Provider Name (Legal Business Name): LORA BALLENGEE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 ORCHARD ST
BROOKVILLE OH
45309-1437
US

IV. Provider business mailing address

77 ORCHARD ST
BROOKVILLE OH
45309-1437
US

V. Phone/Fax

Practice location:
  • Phone: 281-923-0337
  • Fax:
Mailing address:
  • Phone: 281-923-0337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.009136RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: