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General NPI Number Information
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NPI Number | 1346710191
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Entity Type | Individual
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Provider Name | JESSICA LYNN BALKO FNP-C
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Gender | Female
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Dates
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Enumeration Date | 12/04/2018
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 3300 GALLOWS RD
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City | FALLS CHURCH
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State | VA
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Zip | 22042-3307
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Country | US
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Telephone | 703-970-2670
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Fax |
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Provider Business Mailing Address
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Address Line | 431 S COLUMBUS ST APT 611
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City | ALEXANDRIA
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State | VA
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Zip | 22314-3659
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Country | US
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Telephone | 724-433-8486
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024176650
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License Number State | VA
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