Provider Demographics
NPI:1114399953
Name:BAL, HARKIRAT (FNP-C)
Entity Type:Individual
Prefix:
First Name:HARKIRAT
Middle Name:
Last Name:BAL
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3001 DOUGLAS BLVD
Mailing Address - Street 2:STE 325
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4289
Mailing Address - Country:US
Mailing Address - Phone:559-326-1222
Mailing Address - Fax:559-326-1230
Practice Address - Street 1:1791 E FIR AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3840
Practice Address - Country:US
Practice Address - Phone:559-326-1222
Practice Address - Fax:559-326-1230
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-20
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95003003363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA778868OtherREGISTERED NURSE LICENSE
CAF0915028OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION
CA95003003OtherFAMILY NURSE PRACTITIONER LICENSE