Individual
ANGELES L BALLOU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
444 W FORT ST FL 2, BOISE, ID 83702-4535
(208) 422-1018
Mailing address
NBHC NAS MERIDIAN, 1801 FULLER ROAD BLDG 367, MERIDIAN, MS 39309-0001
(601) 679-2210
(601) 679-3232
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
1-112187
AL
363LF0000X
Family Nurse Practitioner
Primary
R854737
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
MS
Enumeration date
01/08/2007
Last updated
06/23/2023
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