Provider Demographics
NPI:1710111372
Name:BALLENGER, WENDY MICHELLE (DO)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:MICHELLE
Last Name:BALLENGER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7148 KERR STREET PLACE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654
Mailing Address - Country:US
Mailing Address - Phone:662-222-6724
Mailing Address - Fax:901-350-5024
Practice Address - Street 1:7148 KERR STREET PLACE
Practice Address - Street 2:SUITE 110
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-3865
Practice Address - Country:US
Practice Address - Phone:662-222-6724
Practice Address - Fax:901-350-5024
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KYR2208207R00000X, 208000000X
MSMS25393207R00000X
MSMS29353208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine