Provider Demographics
NPI:1245632884
Name:BALLAS, MEGAN K
Entity type:Individual
Prefix:MISS
First Name:MEGAN
Middle Name:K
Last Name:BALLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 30589
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73140-1156
Mailing Address - Country:US
Mailing Address - Phone:405-769-3301
Mailing Address - Fax:405-769-9685
Practice Address - Street 1:105 E. SANTA FE
Practice Address - Street 2:DOROTHY SMITH FAMILY MEDICAL CLINIC
Practice Address - City:CARNEY
Practice Address - State:OK
Practice Address - Zip Code:74832
Practice Address - Country:US
Practice Address - Phone:405-865-2020
Practice Address - Fax:405-865-2323
Is Sole Proprietor?:No
Enumeration Date:2014-09-25
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCAPN0000251CNP363LF0000X
NMCNP-02481363LF0000X
OK105652363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily