Provider Demographics
NPI:1821327917
Name:BALOUN, JOHN DAVID (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:BALOUN
Suffix:
Gender:M
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649A HARRIS LN
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-8513
Mailing Address - Country:US
Mailing Address - Phone:615-339-4249
Mailing Address - Fax:
Practice Address - Street 1:1411 W BADDOUR PKWY
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2513
Practice Address - Country:US
Practice Address - Phone:615-443-2531
Practice Address - Fax:615-443-2524
Is Sole Proprietor?:No
Enumeration Date:2009-12-18
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14661363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner