Individual
JESSICA L BALCOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
807 S PONDEROSA ST, PAYSON, AZ 85541-5542
(928) 471-3222
Mailing address
52423 N AZ HWY 188, PAYSON, AZ 85541
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP11809
AZ
Other
Enumeration date
06/19/2018
Last updated
09/24/2018
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