Provider Demographics
NPI:1972153450
Name:BALKA, STEPHEN DALE (NP)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:DALE
Last Name:BALKA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:856 J CLYDE MORRIS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-316-5800
Mailing Address - Fax:757-534-5190
Practice Address - Street 1:191 FOX HILL RD STE D
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-2360
Practice Address - Country:US
Practice Address - Phone:757-850-1311
Practice Address - Fax:757-850-7315
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2019-10-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0024178215363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily