Provider Demographics
NPI:1316130909
Name:BALLENGER, LINDA LOU
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:LOU
Last Name:BALLENGER
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 1:258 LAKE TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-5528
Mailing Address - Country:US
Mailing Address - Phone:615-406-8797
Mailing Address - Fax:
Practice Address - Street 1:311 23RD AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1503
Practice Address - Country:US
Practice Address - Phone:615-340-7781
Practice Address - Fax:615-340-7792
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000078549163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse