Provider Demographics
NPI:1083890040
Name:BALLINGER, GAYANNE JEAN (NP)
Entity Type:Individual
Prefix:
First Name:GAYANNE
Middle Name:JEAN
Last Name:BALLINGER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10904 KINGSTON PIKE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-2931
Mailing Address - Country:US
Mailing Address - Phone:865-288-3754
Mailing Address - Fax:865-288-3809
Practice Address - Street 1:10904 KINGSTON PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-2931
Practice Address - Country:US
Practice Address - Phone:865-288-3754
Practice Address - Fax:865-288-3809
Is Sole Proprietor?:No
Enumeration Date:2008-01-21
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6672363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner