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NPI Code Detail

MEDICARE: NICOLE K BALLEW

MEDICARE: NICOLE K BALLEW
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
1235Z00000XSpeech-Language Pathologist2202012245VA

General Provider Information

NPI Number : 1679369086
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE K BALLEW
Provider Business Mailing Address
First Line : 5604 VIRGINIA BEACH BLVD # A
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23462-5631
Country : US
Telephone Number : 757-455-5000
Fax Number :
Provider Business Practice Location Address
First Line : 5604 VIRGINIA BEACH BLVD # A
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23462-5631
Country : US
Telephone Number : 757-455-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/15/2025
Last Update Date : 12/15/2025

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Directions to “ NICOLE K BALLEW ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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