Provider Demographics
NPI:1275183816
Name:BALAKRISHNAN, LEEGIA (NP)
Entity Type:Individual
Prefix:
First Name:LEEGIA
Middle Name:
Last Name:BALAKRISHNAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LEEGIA
Other - Middle Name:
Other - Last Name:BALAKRISHNAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AGACNP-BC
Mailing Address - Street 1:408 OAK COVE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7518
Mailing Address - Country:US
Mailing Address - Phone:803-261-4455
Mailing Address - Fax:
Practice Address - Street 1:6439 GARNERS FERRY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1638
Practice Address - Country:US
Practice Address - Phone:803-776-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23236363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care