Provider Demographics
NPI:1891179826
Name:BALIK, BRITTNEY (PA-C)
Entity Type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:
Last Name:BALIK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 KENYON RD
Mailing Address - Street 2:SUITE S
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5776
Mailing Address - Country:US
Mailing Address - Phone:515-574-6800
Mailing Address - Fax:
Practice Address - Street 1:800 KENYON RD
Practice Address - Street 2:SUITE S
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5776
Practice Address - Country:US
Practice Address - Phone:515-574-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA078997363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant