MEDICARE: MR. JAMES TERRY BALLENTINE CRNP

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	363LA2200X	Adult Health Nurse Practitioner	AP7090	AZ

General Provider Information

NPI Number	:	1477708071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES TERRY BALLENTINE CRNP

Provider Business Mailing Address
First Line	:	2929 E THOMAS RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-8034
Country	:	US
Telephone Number	:	602-470-5000
Fax Number	:	602-470-5064

Provider Business Practice Location Address
First Line	:	1101 N CENTRAL AVE # 201
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85004-1808
Country	:	US
Telephone Number	:	602-344-6550
Fax Number	:

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

Provider Enumeration Date	:	11/24/2008
Last Update Date	:	08/26/2020

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