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General NPI Number Information
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NPI Number | 1376033969
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Entity Type | Individual
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Provider Name | CRYSTAL AMANDA BALSON NP-C
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Gender | Female
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Dates
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Enumeration Date | 05/18/2018
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Last Update Date | 05/18/2018
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Provider Practice Location Address
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Address Line | 11345 ALAMO RANCH PKWY STE 202
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City | SAN ANTONIO
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State | TX
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Zip | 78253-6442
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Country | US
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Telephone | 210-688-9190
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Fax | 877-936-8202
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Provider Business Mailing Address
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Address Line | 15464 W FM 471 LOT 54
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City | SAN ANTONIO
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State | TX
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Zip | 78253-4617
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Country | US
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Telephone | 210-643-6204
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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 | P3733
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License Number State | TX
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