Basic Information
| Provider Information | |||||||||
| NPI: | 1780631663 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALLINGER | ||||||||
| FirstName: | NANCY | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 337 | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672010337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166607600 | ||||||||
| FaxNumber: | 3169415075 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 S BROADWAY AVE | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672024304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166609600 | ||||||||
| FaxNumber: | 3166609660 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 07/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 13-50216-032 | KS | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 363LP0808X | 45688 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 161482 | 01 | KS | BLUE CROSS BLUE SHIELD | OTHER | 8861 | 01 | KS | PREFERRED HEALTH SYSTEMS | OTHER |