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NPI Code Detail

MEDICARE: MRS. LORA BALLENGEE PA

MEDICARE: MRS. LORA BALLENGEE PA
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
1363A00000XPhysician Assistant50.009136RXOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1316669906
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LORA BALLENGEE PA
Provider Business Mailing Address
First Line : PO BOX 381468
Second Line :
City : GERMANTOWN
State : TN
Zip : 38183-1468
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 75 SYLVANIA DR
Second Line :
City : DAYTON
State : OH
Zip : 45440-3237
Country : US
Telephone Number : 937-320-5050
Fax Number : 937-320-5060
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2022
Last Update Date : 02/09/2026

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Directions to “ MRS. LORA BALLENGEE PA” Practice Location

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