# BALANCE FAMILY PRACTICE & MEDICAL SPA LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255829149
- **Authorized official:** SCARLETT NICOLE VIRDEN DNP APRN FNP-C (OWNER OPERATOR)
- **Authorized official phone:** (918) 397-5437

## Contact information

- **Practice address:** 10330 STATE HWY 10, PAWHUSKA, OK 74056
- **Practice address phone:** (918) 397-5437
- **Practice address fax:** (918) 398-9316
- **Mailing address:** 10330 STATE HIGHWAY 10, BARTLESVILLE, OK 74056
- **Mailing address phone:** (918) 397-5437
- **Mailing address fax:** (918) 398-9316

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 93576 | OK | Yes |

## Other

- **Enumeration date:** 04/25/2018
- **Last updated:** 02/01/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200789230A | — | OK |