Basic Information
| Provider Information | |||||||||
| NPI: | 1538812979 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALIN | ||||||||
| FirstName: | KIRSTEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6062 OCONNER RD | ||||||||
| Address2: | |||||||||
| City: | KLAMATH FALLS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 976039722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418924012 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2821 DAGGETT AVE | ||||||||
| Address2: | |||||||||
| City: | KLAMATH FALLS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 976011129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412748400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2022 | ||||||||
| LastUpdateDate: | 01/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 202114190 | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.