Provider Demographics
NPI:1093481129
Name:BALLINGER, HALEY NICOLE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:HALEY
Middle Name:NICOLE
Last Name:BALLINGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 OAKLEIGH CIR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-2862
Mailing Address - Country:US
Mailing Address - Phone:318-355-6680
Mailing Address - Fax:
Practice Address - Street 1:1850 9TH ST W
Practice Address - Street 2:
Practice Address - City:COLUMBIA FALLS
Practice Address - State:MT
Practice Address - Zip Code:59912-4410
Practice Address - Country:US
Practice Address - Phone:406-892-3206
Practice Address - Fax:406-892-2381
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
MTMED-PAC-LIC-112970363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant