MEDICARE: MS. HALEY NICOLE BALLINGER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant
2	363A00000X	Physician Assistant	MED-PAC-LIC-112970	MT

General Provider Information

NPI Number	:	1093481129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HALEY NICOLE BALLINGER PA-C

Provider Business Mailing Address
First Line	:	3311 OAKLEIGH CIR
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-2862
Country	:	US
Telephone Number	:	318-355-6680
Fax Number	:

Provider Business Practice Location Address
First Line	:	1850 9TH ST W
Second Line	:
City	:	COLUMBIA FALLS
State	:	MT
Zip	:	59912-4410
Country	:	US
Telephone Number	:	406-892-3206
Fax Number	:	406-892-2381

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2021
Last Update Date	:	02/19/2024

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