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General NPI Number Information
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NPI Number | 1255829149
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Entity Type | Organization
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Legal Business Name | BALANCE FAMILY PRACTICE & MEDICAL SPA LLC
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Dates
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Enumeration Date | 04/25/2018
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Last Update Date | 02/01/2024
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Provider Practice Location Address
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Address Line | 10330 STATE HWY 10
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City | PAWHUSKA
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State | OK
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Zip | 74056
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Country | US
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Telephone | 918-397-5437
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Fax | 918-398-9316
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Provider Business Mailing Address
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Address Line | 10330 STATE HIGHWAY 10
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City | BARTLESVILLE
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State | OK
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Zip | 74056
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Country | US
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Telephone | 918-397-5437
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Fax | 918-398-9316
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Authorized Official
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Title or Position | OWNER OPERATOR
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Name | SCARLETT NICOLE VIRDEN
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Credential | DNP APRN FNP-C
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Telephone | 918-397-5437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 93576
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License Number State | OK
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