Provider Demographics
NPI:1881339182
Name:BALISKY, TIMOTHY ALAN (APRN, PMHNP-BC)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:ALAN
Last Name:BALISKY
Suffix:
Gender:M
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5426 BEDFORDSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-9384
Mailing Address - Country:US
Mailing Address - Phone:951-310-4957
Mailing Address - Fax:
Practice Address - Street 1:301 MCCULLOUGH DR STE 520
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-1336
Practice Address - Country:US
Practice Address - Phone:704-332-8787
Practice Address - Fax:704-332-8788
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5016133363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5016133OtherBOARD OF NURSING