Provider Demographics
NPI:1538684857
Name:BALLINGER, SARAH (NPC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:BALLINGER
Suffix:
Gender:F
Credentials:NPC
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1227 N STATE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2002
Mailing Address - Country:US
Mailing Address - Phone:601-974-5637
Mailing Address - Fax:601-974-5605
Practice Address - Street 1:2969 CURRAN DR N STE 200
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216
Practice Address - Country:US
Practice Address - Phone:601-974-5600
Practice Address - Fax:601-974-5699
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2022-04-27
Deactivation Date:2018-06-04
Deactivation Code:
Reactivation Date:2018-06-12
Provider Licenses
StateLicense IDTaxonomies
MS902023363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS902023OtherSTATE LICENSE