Provider Demographics
NPI:1275175093
Name:BALLENGER, CARRIE LAXTON (APRN)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:LAXTON
Last Name:BALLENGER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:ELIZABETH
Other - Last Name:LAXTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:2094 WOODRUFF ROAD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607
Mailing Address - Country:US
Mailing Address - Phone:864-676-9729
Mailing Address - Fax:864-676-9432
Practice Address - Street 1:2094 WOODRUFF ROAD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607
Practice Address - Country:US
Practice Address - Phone:864-676-9729
Practice Address - Fax:864-676-9432
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23317363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health