Provider Demographics
NPI:1518420629
Name:BALLOU, JENNIFER (APRNCNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BALLOU
Suffix:
Gender:F
Credentials:APRNCNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:KNOUS BALLOU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRNCNP
Mailing Address - Street 1:801 MEDICAL DR STE A
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-4030
Mailing Address - Country:US
Mailing Address - Phone:419-222-6622
Mailing Address - Fax:419-224-0015
Practice Address - Street 1:801 MEDICAL DR STE A
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-4030
Practice Address - Country:US
Practice Address - Phone:419-222-6622
Practice Address - Fax:419-224-0015
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRNCNP024498363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner