MEDICARE: SIMRAN BAL FNP

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	363LF0000X	Family Nurse Practitioner	905741	MS

General Provider Information

NPI Number	:	1831951151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIMRAN BAL FNP

Provider Business Mailing Address
First Line	:	112 ROCKBRIDGE XING
Second Line	:
City	:	CLINTON
State	:	MS
Zip	:	39056-5035
Country	:	US
Telephone Number	:	601-421-4486
Fax Number	:

Provider Business Practice Location Address
First Line	:	4001 HARRISON AVE NW
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98502-5084
Country	:	US
Telephone Number	:	360-704-2362
Fax Number	:

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

Provider Enumeration Date	:	01/24/2024
Last Update Date	:	03/02/2026

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