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General NPI Number Information
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NPI Number | 1881339182
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Entity Type | Individual
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Provider Name | TIMOTHY ALAN BALISKY APRN, PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 05/02/2022
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 301 MCCULLOUGH DR STE 520
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City | CHARLOTTE
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State | NC
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Zip | 28262-1336
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Country | US
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Telephone | 704-332-8787
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Fax | 704-332-8788
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Provider Business Mailing Address
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Address Line | 5426 BEDFORDSHIRE AVE
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City | HARRISBURG
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State | NC
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Zip | 28075-9384
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Country | US
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Telephone | 951-310-4957
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 5016133
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License Number State | NC
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