Healthcare Provider Details

I. General information

NPI: 1255256954
Provider Name (Legal Business Name): LIA SKYE BALLOU RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 8TH AVE
SPOKANE WA
99204-2307
US

IV. Provider business mailing address

7448 N 16TH ST
DALTON GARDENS ID
83815-9513
US

V. Phone/Fax

Practice location:
  • Phone: 509-474-5016
  • Fax:
Mailing address:
  • Phone: 406-396-1808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN60394675
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: