Provider Demographics
NPI:1659875565
Name:BALINGIT, REVKAH (NP-C)
Entity Type:Individual
Prefix:
First Name:REVKAH
Middle Name:
Last Name:BALINGIT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 PERCY AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-6942
Mailing Address - Country:US
Mailing Address - Phone:864-551-1356
Mailing Address - Fax:
Practice Address - Street 1:661 RUTHERFORD RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-4640
Practice Address - Country:US
Practice Address - Phone:864-569-6131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145561363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology