Provider Demographics
NPI:1225451925
Name:BALCH, LEAH ASHLEY (AGPCNP)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:ASHLEY
Last Name:BALCH
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:ASHLEY
Other - Last Name:SIMMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:509 MED TECH PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2579
Mailing Address - Country:US
Mailing Address - Phone:423-302-6565
Mailing Address - Fax:423-952-2175
Practice Address - Street 1:1406 TUSCULUM BLVD STE 1200
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4341
Practice Address - Country:US
Practice Address - Phone:423-787-6370
Practice Address - Fax:423-787-6371
Is Sole Proprietor?:No
Enumeration Date:2014-01-31
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18140363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6010370OtherBCBST
TN1035029I85Medicare PIN