Provider Demographics
NPI:1780631663
Name:BALLINGER, NANCY (ARNP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:BALLINGER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-0337
Mailing Address - Country:US
Mailing Address - Phone:316-660-7600
Mailing Address - Fax:316-941-5075
Practice Address - Street 1:350 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-4304
Practice Address - Country:US
Practice Address - Phone:316-660-9600
Practice Address - Fax:316-660-9660
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-50216-032163WP0808X
KS45688363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS161482OtherBLUE CROSS BLUE SHIELD
KS8861OtherPREFERRED HEALTH SYSTEMS