Provider Demographics
NPI:1578156030
Name:BALOK, AMY KATHLEEN
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KATHLEEN
Last Name:BALOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4529 ISLAND WATERS DR
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-8078
Mailing Address - Country:US
Mailing Address - Phone:231-838-1738
Mailing Address - Fax:
Practice Address - Street 1:178 TURNERSBURG HWY
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-2890
Practice Address - Country:US
Practice Address - Phone:704-872-6355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-16
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251725163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care