=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225451925
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEAH ASHLEY BALCH AGPCNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2014
-----------------------------------------------------
Last Update Date | 07/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1406 TUSCULUM BLVD STE 1200
-----------------------------------------------------
City | GREENEVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37745-4341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-787-6370
-----------------------------------------------------
Fax | 423-787-6371
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 509 MED TECH PKWY STE 100
-----------------------------------------------------
City | JOHNSON CITY
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37604-2579
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-302-6565
-----------------------------------------------------
Fax | 423-952-2175
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 18140
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Nurse Practitioner
-----------------------------------------------------
License Number | 18140
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------