Healthcare Provider Details

I. General information

NPI: 1770688210
Provider Name (Legal Business Name): PATRICIA ROUISSE BALLENTINE R.N., MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 06/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 STAGECOACH TRL SUITE 200A
SAN MARCOS TX
78666-5134
US

IV. Provider business mailing address

7005 MIRA LOMA LN STE 102
AUSTIN TX
78723
US

V. Phone/Fax

Practice location:
  • Phone: 512-396-4700
  • Fax: 512-396-4796
Mailing address:
  • Phone: 512-795-4344
  • Fax: 512-928-9466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number504232
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: